Confidential Financial Assessment • Zero Obligation

Schedule Your Free Practice Revenue Audit

Our senior AAPC-certified billing directors will conduct an objective, line-item diagnosis of your practice’s clean claim rate, aging accounts receivable, and top denial codes under a mutual BAA.

Practice Identification & Contact

Full Name & Professional Title *

Practice / Clinic Legal Name *

Work / Practice Email *

Direct Telephone Number *

Clinical Scope & Financial Scale

Primary Clinical Specialty *

Number of Billing Providers (MD, DO, NP, PA) *

Estimated Monthly Gross Billing Volume *

Primary EHR / Practice Management Software *

Primary Revenue Challenges You Wish to Audit (Select all that apply)

High / Unexplained Denial RatesStagnant Aging A/R (>60 / >90 Days)Biller Turnover & Staffing GapsCredentialing & Payer Enrollment DelaysMissing Clean Claim Pre-Scrubbing

Additional Notes or Specific Payer Friction (Optional)

HIPAA & Privacy Assurance: Submitting this form does NOT transmit any patient Protected Health Information (PHI). Prior to receiving or reviewing any claims data, Smart Revenue RCM LLC executes a formal, mutual Business Associate Agreement (BAA) with your practice.

Institutional Turnaround SLA: Review & Outreach within 1 Business Day