Kompanie Healthcare Partners LLP

Healthcare Quality of Revenue (QoR) Due Diligence

Going beyond accounting Quality of Earnings (QoE) to uncover defensive undercoding, unbilled clinical ancillaries, and toxic payer clawback exposure before deploying capital.

Traditional Quality of Earnings (QoE) reports prepared by Big 4 accounting firms examine cash-to-accrual reconciliations and historical EBITDA, but completely miss clinical coding risk. A clinic showing $2M in historical EBITDA may actually be committing systematic defensive undercoding (billing level 3 E/M 99213 for complex level 4 chronic care encounters out of audit fear), or silently writing off 15% of claims under toxic CARC denial codes (CO-16, CO-45, CO-97). Kompanie LLP conducts forensic pre-LOI Quality of Revenue (QoR) diligence across 1,000+ random patient encounters. We quantify exact revenue upside, identify unbilled clinical ancillaries (GLP-1, BHRT, ultrasound guidance), and eliminate post-closing surprises.

Deliverables

  • 1,000-encounter clinical documentation and CPT coding bell-curve comparison against regional Medicare MAC benchmarks.
  • Forensic 90-day denial audit identifying unappealed CO-16, CO-45, and CO-97 CARC codes recoverable under ERISA 502(a).
  • Payer mix concentration risk analysis (Commercial PPO, Medicare Advantage, Medicaid, Self-Pay).
  • Post-close 90-day RCM optimization roadmap delivered directly to the MSO executive team.

Frequently asked questions

Why is E/M bell-curve analysis critical in primary care and specialty MSO roll-ups?

Due to fear of audits, many solo physicians bill 99213 for 70%+ of patient visits despite documenting Medical Decision Making (MDM) supporting 99214. Correcting this defensive undercoding under CPMA guidelines captures an immediate $42–$68 incremental cash collection per encounter without adding patient volume.

How does QoR diligence protect PE sponsors from post-acquisition recoupments?

We identify systemic billing patterns that trigger payer audits or False Claims Act exposure. By discovering these issues pre-closing, buyers can negotiate indemnification escrows, purchase price reductions, or rep-and-warranty insurance exclusions.