8-provider cardiology group — $3.2M in recoverable revenue and compliance risk identified.
An anonymized illustration of a real 2026 engagement. Numbers are exact. Practice identity is withheld pending client authorization to name them. The structure and findings mix is representative of what specialty groups at this scale typically uncover.
About this engagement
- Practice type
- Independent cardiology group
- Size
- 8 providers across 2 locations
- Engagement
- Full Practice Assessment, Q1 2026
- Dataset
- 11 years of Medicare claims + public web signals
- Delivery
- Report + dashboard activation in 3 weeks
Findings — by domain
E&M coding variance vs specialty peers
Established-patient E&M distribution skewed two levels below specialty 75th percentile across 6 of 8 providers. Documentation supported higher levels on claims reviewed.
NCCI bundling risks
16 procedure-procedure pairs billed together that CCI edits flag as inherently bundled or requiring modifier 59. Audit exposure plus unbilled modifiers.
Modifier misalignment
Modifier -25 underutilized on same-day E&M + procedure encounters. Modifier -26/TC split omitted on diagnostic imaging in 40% of applicable claims.
Projected payment adjustment gap
Cardiology-weighted quality measure score projected at 62/100 vs specialty median of 78. Three highest-lift measures identified with data sources already available.
ADA accessibility violations on public site
axe-core detected 127 WCAG 2.1 AA violations across the patient-facing site, including unlabeled forms, missing alt text, and insufficient color contrast. Matches the profile cited in recent ADA Title III healthcare settlements.
HIPAA tracking-pixel exposure
Google Tag Manager + Meta Pixel detected on patient-facing pages. Per OCR 2022 bulletin, these trigger HIPAA enforcement scope when present on health-related pages even without PHI being transmitted.
Provider productivity spread
Work RVU per provider varies 2.4x across the 8-provider group. Top performer patterns identified as replicable levers (scheduling density, procedure mix).
Payer rate underpayment signals
3 commercial contracts paying below Medicare + 10% benchmark on high-volume codes. Renegotiation leverage documented per code.
What happened next
The practice moved into Ralt Rounds to operationalize the findings. Billing alignment work started on the three highest-impact modifier and E&M gaps within week two. Website compliance remediation (ADA + tracking-pixel removal) was scheduled with the practice’s existing web developer, with Ralt providing before/after scanner reports as acceptance criteria.
Continuous monitoring on the dashboard flags new CCI edits as CMS publishes quarterly updates, alerts on MIPS measure drift, and re-runs the four compliance scanners monthly.
What would your numbers look like?
Every assessment is specialty-benchmarked. Cardiology sees different levers than primary care, which sees different levers than orthopedics. A 30-minute discovery call is the starting line.
Schedule a discovery call