What an assessment helps your practice decide

Explore a fictional primary-care practice’s opportunity brief. See the starting facts, the evidence still needed and a next action for each workflow.

All practice facts below are fictional. No real NPI, patient records or live CMS lookup are used. This is a sample format, not a generated assessment, eligibility determination, client result or revenue forecast. You can view it without providing information.

Fictional practice inputs

Sample Family Practice

Team: Two primary-care clinicians with an existing office team
Patient needs: Hypertension, diabetes and ongoing care coordination
Current workflows: Manual reminders, ad hoc follow-up and authorization-related claim requests

Assessment summary

Validate a focused starting point

Start by assessing a care-program workflow and measuring one routine-call task. Review claims evidence separately before choosing billing changes.

Staffing capacity is an open question. Confirm available hours, required qualifications and supervision before selecting in-house or supported delivery.

An opportunity screen identifies what to evaluate. It does not establish that a program can be billed.

Opportunities and evidence gaps

These sample findings show how a current practice fact becomes a specific question and action, without turning it into an unsupported financial claim.

Care programs

Evaluate an initial home-monitoring workflow

Candidate for evaluation

Starting fact: The fictional practice reports patients with hypertension and no established connected-device workflow.
What still needs verification: Patient-level medical necessity, consent, program requirements, payer coverage and staff capacity remain unverified.
Next action: Have the clinician define a suitable population, then validate the payer and delivery requirements for Remote Patient Monitoring (RPM).
Suggested owner: Clinical lead and program operations

Care coordination

Assess a structured chronic-care workflow

Eligibility review needed

Starting fact: The practice reports patients with multiple chronic conditions and ad hoc follow-up.
What still needs verification: Multiple diagnoses alone do not establish Chronic Care Management (CCM) eligibility. Existing programs, service requirements and billing compatibility need review.
Next action: Confirm the appropriate care-program model, consent process and care-plan responsibilities before enrollment.
Suggested owner: Billing practitioner and care-team lead

Front-office operations

Review routine call workload

Workflow review needed

Starting fact: Staff report spending time on appointment confirmations and preparation reminders.
What still needs verification: Call volume, response rates, scripts and escalation needs are not yet measured.
Next action: Map one administrative call workflow. Compare staff time and unresolved follow-up before choosing an automation scope.
Suggested owner: Practice administrator

Revenue cycle

Validate the reason claims need follow-up

Claims evidence needed

Starting fact: The practice reports payer requests for missing authorization information.
What still needs verification: No claim-level evidence or payer-specific root-cause review has been completed. Revenue recovery cannot be estimated from this report.
Next action: Review an authorized claim sample and assign owners for recurring exceptions, corrections and payer follow-up.
Suggested owner: Billing lead

A next-step plan for this example

Clinical lead: select the care workflow worth validating.
Administrator: confirm staff capacity, systems and the call process.
Billing lead: verify payer requirements and review claim exceptions.
Practice team: agree the initial scope and how progress will be measured.

A live assessment uses your verified public profile and current aggregate practice context. Do not enter patient-identifying information.

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