Your practice is losing revenue in places you cannot currently see.
And you cannot trace it to a cause.
Specialty surgical practices lose revenue in three places — before the visit, between the referral and the appointment, and after billing. They know it is happening. They have never been able to quantify how much, or where to start. Prexisio answers both questions using their own data.
Where practices lose revenue — the three questions that go unanswered
Which cancellations were preventable — and which location is actually driving them?
Most practices know their cancellation rate. Almost none can explain it by cause, location, or referral source. That means the fix is always organization-wide — even when the problem is not.
When you cannot trace it, you cannot target it. The rate stays where it is.
See what Prexisio surfaces for your practiceMost practices cannot answer any of these three questions from their current systems. That is not a gap in effort. It is a gap in infrastructure.
The data that would answer the question exists.It has just never been connected into a single answer.
Multi-site specialty surgical practices generate data at every point in the patient journey — scheduling, referrals, prior auth, procedures, billing. The problem is not a shortage of data. It is that nobody has ever put it together in a way that answers the questions leadership is actually asking. So the questions stay open. And the revenue keeps leaving.
- Your cancellation rate is a number. When leadership asks which locations are driving it and why, the honest answer is that nobody can fully explain it from the data.
- Prior authorization denials are causing 48-hour cancellations. You know this is happening. You do not know which payers, which procedures, or how much it is costing — because nobody has connected the auth records to the surgical schedule.
- You have three locations performing at different levels. The data to explain the gap exists across your scheduling system, your ASC platform, and your billing records. It has never been connected.
What it looks like when it is fixed
A multi-site pain management group reduced their surgical cancellation rate from 30% to under 12% after Prexisio decomposed the root cause by location, referral source, and prior auth status. The fix was targeted — not organization-wide — because the data showed exactly where to act.
- Your payer contracts are PDFs sitting with legal. Nobody has compared what the contracts say you are owed against what actually arrived in the bank. That gap has been accumulating quietly for years.
- A payer sent a recoupment demand. The exposure exists because the reconciliation was never built. The data to defend the position — and recover what is owed — is in your billing system. Nobody has run it.
- The CFO asks for a clean view of revenue by location, by payer, by CPT code. The answer requires pulling from three systems that assign different patient IDs to the same person. That report has never been produced.
What it looks like when it is fixed
A PE-backed GI group had never reconciled their payer contracts against actual payments. When Prexisio digitized the contracts and ran the reconciliation, the underpayment gap across three payers exceeded $2M in recoverable revenue the organization had no visibility into.
Both problems have the same cause.
You cannot explain why your cancellation rate is where it is. You cannot tell which referral sources are actually converting to completed procedures. You cannot quantify how much of what you billed last month you did not collect — or why.
Prexisio answers all three questions — using your data, with a specific dollar amount attached to every finding.
The questions your data should be answering right now.
These are not hypothetical questions. They are the decisions your leadership team is trying to make every month — about scheduling, referrals, and what billing is actually recovering. If your current systems cannot answer them, that is not a gap in effort. It is a gap in infrastructure.
What is your cancellation rate by location — and which referral sources are driving it?
Most practices can give you the rate. Almost none can give you the breakdown by cause, location, and referring source in the same answer. That means every intervention is organization-wide — even when the problem is not.
Before the VisitWhich procedures scheduled in the next 30 days are at risk of a 48-hour cancellation because prior authorization has not been confirmed?
If this list does not exist in your organization right now — mapped to the surgical schedule and updated weekly — you are managing prior auth reactively. The 48-hour cancellation is the most preventable and the most expensive.
Before the VisitWhich referring physicians are sending patients who actually complete procedures — and which ones are not?
Referral volume is easy to count. Referral quality requires connecting the referral record to the surgical outcome. Most practices have never done it, which means they are allocating the same capacity to sources that perform very differently.
Referral to AppointmentOf every referral you received last quarter, how many converted to a completed procedure — and where in the process did the rest fall out?
The gap between referral received and procedure performed is where growth leakage hides. Scheduled but not kept. Kept but cancelled. Cancelled but not rebooked. Each category has a different fix. Most practices treat them as one number.
Referral to AppointmentAre your payers paying what your contracts say they owe — and if not, which payers, which codes, and how much?
Contracts say what you are owed. Your billing system shows what arrived. The gap between them — from underpayments, bundling errors, and missed adjustments — has been accumulating at most practices for years without anyone running the reconciliation.
After BillingFor the procedures you performed last month, how much of the allowed amount did you actually collect — and what is driving the shortfall?
The difference between allowed amount and actual payment is not always patient cost-sharing. Billing setting errors, coding gaps, and claim-level failures each produce the same symptom — revenue left on the table after the work is already done.
After BillingEvery one of these questions has a specific answer in your data. Prexisio surfaces it — not as a benchmark or an industry average, but as a number from your own records.
See how we answer themYour current vendors address the outcome.None of them diagnose the cause.
Every tool and vendor your practice already uses serves a real purpose. The gap is not in what they do — it is in the questions they cannot answer. Why is the cancellation rate where it is. Which referrals are not converting. Where billing is leaving revenue on the table. Those answers require a different kind of work.
What Prexisio delivers that nothing else does
- A cancellation rate decomposed by cause, location, and referral source — so leadership knows exactly where to act, not just what the number is
- A prior auth risk list mapped to your surgical schedule, updated weekly, before the 48-hour cancellation window closes
- Referral quality measured by whether the patient actually completed the procedure — not whether they were scheduled
- A view of which referral sources are driving revenue and which are filling your schedule with patients who do not show up
- A payer reconciliation that compares what your contracts say you are owed against what actually arrived — with the gap quantified by payer and code
- A specific dollar amount on every finding, derived from your own data — not a benchmark, not an industry estimate
RCM Vendors
Process claims, manage collections, chase denials.
They work on billing after it is submitted. They do not diagnose why your cancellation rate is at 28%, which referral sources are not converting, or where the revenue gap in your billing is actually coming from.
EHR Analytics
Reporting within your EMR — appointments, encounters, patient records.
Single-system view only. Your EMR does not know what your ASC platform recorded, which referrals converted, or what your billing system actually collected. The questions that matter require all three.
Scheduling Software
Reminders, waitlists, patient communication tools.
Reduces no-shows at the margin. Cannot tell you that prior auth lag with one specific payer is the real driver of your 48-hour cancellations — or which referral sources are sending patients who cancel at twice the rate.
Management Consultants
High-level strategy, process recommendations, organizational design.
Can identify a problem category. Cannot deliver a specific dollar amount from your own billing records, a weekly prior auth risk list mapped to your schedule, or a referral-to-completion rate by source.
Where Prexisio sits
High diagnostic depth. Built specifically for specialty surgical practices. No one else is here.
Every other option is either generic across industries or shallow in what it can actually answer. Prexisio tells you where you are losing revenue before the visit, which referrals are not converting, and how much billing is leaving on the table — with a specific dollar amount from your own data on every finding. Built exclusively for multi-site pain management, GI, spine, and orthopedic practices.
Management Consultants
Strategic level only — no recurring data, no practice-specific numbers
PREXISIO
Revenue intelligence across all three leakage points — your data, your numbers
RCM Vendors
Billing and collections — outcome layer, not cause layer
EHR Analytics
Single-system view — scheduling, referrals, and billing never connected
The blank space in the top-right quadrant is where Prexisio operates. It is empty because nobody built this diagnostic capability for specialty surgical practices before.
See what we diagnoseFrom first conversation to full visibility.
Most organizations wait months for analytical work to produce anything useful. The first Prexisio findings land in front of your leadership team within 30 days of data access.
The Diagnostic Assessment
A focused conversation where we ask the questions that reveal whether your practice has recoverable revenue sitting in your data. You leave with a specific dollar estimate — not a range, not a benchmark. The number for your organization.
No pitch. No demo. If we do not see a clear opportunity we will tell you.
Data Access and Foundation
We get access to your scheduling, referral, and billing data and build the foundation that allows us to answer all three revenue leakage questions accurately. We verify every data source before running a single analysis.
Your data never leaves your environment. We work with read-only access inside your infrastructure.
The Diagnostic Sprint
We run the full analysis — cancellations decomposed by cause, location, and referral source; referral conversion from received to completed procedure; and the gap between what your payers owe and what they paid. You get findings, dollar amounts, and three prioritized actions.
The findings presentation goes to your COO, CFO, and CEO. Every number is sourced to the query that produced it.
Ongoing Intelligence
Every diagnostic module refreshed with current data and delivered by the 10th of each month. Biweekly advisory calls. Quarterly strategic review. The intelligence layer your organization has never had — connected to last month's decisions every time.
You own the system. We stay responsible for what it produces. A departure is an HR event, not a reporting crisis.
The assessment is where it starts.
Forty-five minutes. Diagnostic questions calibrated to your specialty. One specific dollar amount. If we do not see a clear opportunity in your data, we will tell you before you commit to anything.
Specialty-specific.Not one size fits all.
Every diagnostic playbook is built from operational experience inside real specialty surgical organizations. The questions we ask, the data tables we query, the fields we verify, and the benchmarks we measure against are calibrated to your specialty — not adapted from a generic healthcare template.
Different systems
A pain management group runs different software than a GI practice or a spine surgery center. The data structures, the terminology, and the operational workflows are different. Generic analysis does not reflect that. Specialty-specific does.
Different cancellation drivers
In pain management, prior auth is the #1 cause. In GI, it is patient prep failure. In orthopedics, it is implant availability. The diagnostic has to know the difference.
Different benchmarks
A 15% cancellation rate in spine surgery means something different from 15% in colonoscopy scheduling. Benchmarks without specialty context are noise.
Pain Management
Common systems: Integy · HST Pathways · ModMed
- Prior auth as the #1 driver of 48-hour cancellations
- Scheduled-to-perform funnel across clinic and ASC locations
- Referral source quality — volume vs. net revenue per case
- Spinal cord stimulator and implant procedure tracking
Gastroenterology
Common systems: ModMed · AdvancedMD · Nextech
- ASC throughput and endoscopy case stacking optimization
- Colonoscopy scheduling cancellation decomposition
- PE consolidation — multiple systems unified under one view
- Payer mix optimization across acquired GI practices
Spine Surgery
Common systems: HST Pathways · Nextech · Epic
- OR utilization — first case starts and turnover time variance
- Complex case scheduling and block time management
- Implant cost tracking against billed and reimbursed amounts
- Multi-surgeon performance benchmarking by location
Orthopedics
Common systems: Modernizing Medicine · HST · Various
- Block scheduling utilization and surgeon access management
- Joint replacement ASC migration volume and outcome tracking
- Referral source intelligence for sports medicine pipeline
- Implant cost variance analysis by procedure and payer
Not sure where to start? Tell us about your practice and we will tell you where the highest-value diagnostic begins.
Proof of work
Organizations that no longer guess where their revenue is going.
Two engagements. Two specialties. The same pattern — revenue leaving in ways leadership could not see, quantify, or explain.
30% surgical cancellation rate. COO stopped everything and pointed one person at the problem.
A multi-site pain management organization had no data infrastructure when the engagement began. Scheduling lived in Integy. Surgical records were in HST. Lab data was in Telcor. The same patient had a different ID in each system. Nobody had ever connected them.
In June 2019, the COO halted all other analytical work and directed everything toward one question: why is our surgical cancellation rate at 30%, and how do we get it under 10%?
Prexisio connected the scheduling, surgical, and lab records into a single view, constructed the scheduled-to-perform funnel from scratch, and decomposed every cancellation by window (48-hour, 24-hour, date-of-service), location, referral source, payer, and prior authorization status. For the first time, leadership could see not just the rate — but the cause.
Revenue integrity work followed: Prexisio compared billed amounts against contracted allowed amounts across all active payer contracts — which existed only as PDFs with legal and had never been reconciled against actual payments. The underpayment gap, when surfaced, exceeded $2M in recoverable revenue the organization had no visibility into.
30%
Cancellation rate at engagement start
<10%
COO target — achieved through root cause decomposition
$2M+
Underpayment gap identified in payer contract reconciliation
Multiple acquired GI practices. Different systems. Leadership asking for reporting that did not exist.
A management services organization that had acquired multiple gastroenterology practices across different markets. Each practice came in with its own systems, its own patient records, its own payer contracts, and its own operational processes.
The PE ownership needed unified reporting across all acquired practices — AR aging, monthly billing performance, and payer mix — delivered on a recurring schedule. None of it existed in a single place. The reporting infrastructure had never been built.
Prexisio built unified reporting across all acquired practices, delivered three recurring monthly reports without manual assembly, and managed the annual MIPS submission across the organization.
3
Recurring monthly reports delivered on schedule every cycle
Multi
Acquired GI practices unified under one reporting layer
Annual
MIPS submission managed across the full organization
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Find out what your practice is leaving on the table.One call. One number. No obligation.
Forty-five minutes. Diagnostic questions calibrated to your specialty. A specific dollar amount from your actual data — whether the revenue is leaving before the visit, between the referral and the appointment, or after billing. If we do not see a clear opportunity in your data, we will tell you that too.
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