Case Study 5 | Revenue Cycle Audit, Compliance, and Payer Strategy Consulting
GoHealthcare Practice Solutions | Pinky Maniri-Pescasio, MSc, CRCR, CSAPM, CSPPM, CSBI, CSPR, CSAF, Certified in A.I. Governance
Revenue Cycle Audit, Compliance Alignment, and Payer Strategy Engagement
Consultant: Pinky Maniri-Pescasio
CEO & Founder, GoHealthcare Practice Solutions
Medical Practice Consultant
National Speaker on Revenue Cycle Management, Compliance, and Payer Strategy
Client Profile
A multi-specialty medical practice operating in a complex payer environment, managing commercial, Medicare, and workers’ compensation contracts. Despite strong clinical volume, leadership had concerns around revenue inconsistency, payer friction, and audit exposure.
The Challenge
The practice suspected revenue leakage but lacked clear visibility into where breakdowns were occurring. Claim denials, delayed payments, and inconsistent reimbursement were affecting cash flow. Documentation practices varied by provider, coding accuracy was inconsistent, and payer requirements were not always fully aligned with internal workflows.
There were also concerns around compliance risk. Leadership wanted confidence that the practice could withstand payer audits while improving financial performance without disrupting patient care.
My Role
I was engaged as a Medical Practice Consultant to lead a comprehensive revenue cycle audit, compliance review, and payer strategy assessment. In my role as CEO and Founder of GoHealthcare Practice Solutions, I provided objective analysis while working hands-on with leadership and operational teams to implement sustainable improvements.
What I Led
Revenue Cycle and Operational Audit
• Reviewed front-end, mid-cycle, and back-end workflows
• Assessed charge capture, coding accuracy, and documentation alignment
• Analyzed denial trends and payment delays by payer
• Identified revenue leakage and operational inefficiencies
Compliance and Risk Review
• Evaluated documentation against CMS and payer requirements
• Reviewed coding practices for accuracy and consistency
• Assessed audit exposure and compliance gaps
• Delivered clear, actionable remediation guidance
RCM Improvement
• Redesigned workflows to reduce denials and rework
• Improved alignment between clinical documentation and billing
• Strengthened utilization management and prior authorization processes
• Established performance benchmarks and accountability
Payer Negotiations and Strategy
• Analyzed payer contract performance and reimbursement trends
• Identified underperforming contracts and negotiation leverage
• Supported payer negotiations using data-driven justification
• Improved payer communication and escalation pathways
All recommendations were practical, compliant, and aligned with real-world practice operations.
Results
Following the audit and implementation phase:
• Revenue leakage was identified and corrected
• Coding accuracy and documentation consistency improved
• Denials and payment delays decreased
• Compliance confidence increased
• Cash flow stabilized and improved
• Leadership gained clear visibility into revenue cycle performance
• Payer discussions became more structured and effective
Improvements were achieved without disrupting patient care or daily operations.
Why It Mattered
By combining audit rigor with hands-on operational expertise, I helped the practice move from uncertainty to control. Rather than reacting to audits, denials, or payer pressure, leadership gained a proactive, compliant, and financially sound revenue cycle.
This engagement reflects the value of experienced, executive-level medical practice consulting grounded in compliance, payer strategy, and operational reality.
Consultant: Pinky Maniri-Pescasio
CEO & Founder, GoHealthcare Practice Solutions
Medical Practice Consultant
National Speaker on Revenue Cycle Management, Compliance, and Payer Strategy
Client Profile
A multi-specialty medical practice operating in a complex payer environment, managing commercial, Medicare, and workers’ compensation contracts. Despite strong clinical volume, leadership had concerns around revenue inconsistency, payer friction, and audit exposure.
The Challenge
The practice suspected revenue leakage but lacked clear visibility into where breakdowns were occurring. Claim denials, delayed payments, and inconsistent reimbursement were affecting cash flow. Documentation practices varied by provider, coding accuracy was inconsistent, and payer requirements were not always fully aligned with internal workflows.
There were also concerns around compliance risk. Leadership wanted confidence that the practice could withstand payer audits while improving financial performance without disrupting patient care.
My Role
I was engaged as a Medical Practice Consultant to lead a comprehensive revenue cycle audit, compliance review, and payer strategy assessment. In my role as CEO and Founder of GoHealthcare Practice Solutions, I provided objective analysis while working hands-on with leadership and operational teams to implement sustainable improvements.
What I Led
Revenue Cycle and Operational Audit
• Reviewed front-end, mid-cycle, and back-end workflows
• Assessed charge capture, coding accuracy, and documentation alignment
• Analyzed denial trends and payment delays by payer
• Identified revenue leakage and operational inefficiencies
Compliance and Risk Review
• Evaluated documentation against CMS and payer requirements
• Reviewed coding practices for accuracy and consistency
• Assessed audit exposure and compliance gaps
• Delivered clear, actionable remediation guidance
RCM Improvement
• Redesigned workflows to reduce denials and rework
• Improved alignment between clinical documentation and billing
• Strengthened utilization management and prior authorization processes
• Established performance benchmarks and accountability
Payer Negotiations and Strategy
• Analyzed payer contract performance and reimbursement trends
• Identified underperforming contracts and negotiation leverage
• Supported payer negotiations using data-driven justification
• Improved payer communication and escalation pathways
All recommendations were practical, compliant, and aligned with real-world practice operations.
Results
Following the audit and implementation phase:
• Revenue leakage was identified and corrected
• Coding accuracy and documentation consistency improved
• Denials and payment delays decreased
• Compliance confidence increased
• Cash flow stabilized and improved
• Leadership gained clear visibility into revenue cycle performance
• Payer discussions became more structured and effective
Improvements were achieved without disrupting patient care or daily operations.
Why It Mattered
By combining audit rigor with hands-on operational expertise, I helped the practice move from uncertainty to control. Rather than reacting to audits, denials, or payer pressure, leadership gained a proactive, compliant, and financially sound revenue cycle.
This engagement reflects the value of experienced, executive-level medical practice consulting grounded in compliance, payer strategy, and operational reality.