Understanding your results
The number tells you where to look. It doesn’t tell you why.
These estimates help identify questions worth investigating. They are not a diagnosis of your hospital’s utilization-management performance.
What each result means
Modeled inpatient cases at risk
What this means
An estimate of how many inpatient cases could be financially affected under the modeled denial scenario.
Based on
Publicly reported hospital case volume and the calculator's modeled scenario.
What it doesn’t mean
These are not cases we know your hospital actually had denied. We have not reviewed your claims or medical records.
Modeled reimbursement exposure
What this means
An estimate of inpatient reimbursement that could be financially at risk under the modeled scenario.
Based on
This estimate is derived from the modeled number of inpatient cases at risk and the hospital's Medicare inpatient payment benchmark.
What it doesn’t mean
This is not actual lost revenue, guaranteed recoverable revenue, or projected savings. It identifies a financial question that may be worth investigating.
Estimated opportunity to investigate
What this means
The portion of the modeled financial exposure identified for closer case-level investigation.
Based on
The calculator's modeled revenue-risk scenario.
What it doesn’t mean
This is not a prediction that CLIP will recover this amount. Case-level review is required to determine whether an actionable opportunity actually exists.
Estimated annual physician-advisor review cases
What this means
An estimate of the potential physician-advisor review volume associated with the hospital's publicly reported case volume.
What it doesn’t mean
This is not your hospital's actual physician-advisor workload. Hospitals use physician advisors differently, and we do not have your internal review logs.
Estimated PA review workload
What this means
An estimate of physician-advisor time associated with the modeled review volume.
What it doesn’t mean
This is not a measurement of your physician-advisor team's actual workload or staffing.
Estimated PA time potentially returned
What this means
An estimate of physician-advisor time that could potentially be redirected if CLIP supports part of the review workflow.
What it doesn’t mean
Actual impact depends on your hospital's workflow, staffing, review process, and how CLIP is used.
Potential additional review capacity
What this means
An estimate of additional cases that could potentially be reviewed using the same physician-advisor capacity.
What it doesn’t mean
This is modeled capacity, not a guaranteed operational result.
Estimated CLIP review volume
What this means
Because hospitals use physician advisors differently, the calculator shows a Low, Base, and High range rather than assuming one precise review volume.
What it doesn’t mean
These are not your hospital's actual review volumes.
From estimate to answer
Step 1
Public-data signal
Step 2
Opportunity to investigate
Step 3
Case-level validation
Step 4
Understand the cause
Step 5
Target the response
Step 6
Measure the impact
Estimated opportunity is not CLIP savings. Case-level validation determines whether the signal is supported by evidence.
The same financial signal can come from very different problems.
Public data cannot tell us what is happening inside your workflow. Similar financial patterns can have very different causes.
- Review capacity
- Timing of reviews and status decisions
- Clinical documentation
- Status decision consistency
- Escalation
- Physician engagement
- Payer friction
- Workflow configuration
A capacity problem requires a different response from a documentation problem.
The first step is determining which problem you actually have.
From signal to diagnosis.
The CLIP 2-Week Diagnostic Sprint determines what is actually happening.
We review a focused sample of 20–40 cases and the workflow surrounding them to determine whether the opportunity signal is supported by case-level evidence, establish a meaningful baseline, and identify where targeted intervention may be warranted.
What questions can we answer in two weeks?
- Is the opportunity real?
- Where is it occurring?
- What's driving it?
- What should change first?
- How will we know it worked?
Know what problem you’re solving before you solve it.
If your calculator results raise a question worth investigating, the CLIP Diagnostic Sprint is designed to answer it.