For Independent Emergency Medicine Groups
Practice Stewardship
An embedded financial steward for ED physician partnerships.
Most independent ED groups have a billing vendor. Few have someone watching the business of the practice.
Claims go out. Reports come in. Cash moves through the system. On the surface everything looks stable.
Stewardship is the gap between task completion and business protection. Cigal serves as a sustained outside advisor for democratic ED partnerships, watching revenue cycle trends, evaluating payer behavior, keeping vendors accountable, testing collection performance, and translating financial signals so partners can make decisions from a fair, informed position.
The model works because the value compounds. Issues get caught earlier. Vendors operate differently when they know an experienced advisor is reviewing their work. Partners stop debating impressions and start working from evidence.
What's included in a Stewardship engagement
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Monthly revenue cycle and trend review
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Payer and managed care contract enforcement monitoring
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Denial and underpayment analysis
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Physician practice pattern review
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RCM vendor oversight and accountability
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Collection agency performance testing
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Partner-level reporting and communication
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Unbiased interpretation between partners on financial decisions
Engagement model: Monthly retainer. Typical engagement runs 12 months or longer. Designed to throttle down once internal systems and oversight mature, not extend indefinitely.
Cigal worked with one independent emergency medicine partnership under a $5,000 monthly retainer for six years. Over that period, the engagement generated approximately $5 million in additional value against $420,000 in total advisory fees. A return of roughly $11.90 in value per $1 invested.
"Profitability rose 15% in a year. Cigal fixed what mattered. We're no longer buried under low reimbursements."
Dr. George Keng, Fort Atkinson Emergency Physicians
For Hospital Emergency Departments
Facility Revenue Diagnostics
Project-based revenue analysis for hospital ED departments.
Hospital ED departments often run on facility E/M structures, acuity guidelines, and charge capture workflows that were designed years ago and haven't been re-examined since. Volume changed. Payer mix shifted. Documentation patterns evolved. The structure underneath stayed the same.
A Facility Revenue Diagnostic is a focused engagement that examines whether the structure behind your ED's revenue still reflects how care is being delivered today. The work produces a clear answer, defined recommendations, and a measurable opportunity.
What's included in a Diagnostic engagement
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Baseline calculation (charges, payments, visits, charge-per-visit, payment-per-visit)
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Fee schedule comparison against Medicare locality and usual and customary rates
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EOB and payer behavior analysis on a representative claim sample
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Coding and documentation audit on a chart sample sized to the volume
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Acuity distribution and physician productivity analysis
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Written findings with annualized financial impact and prioritized recommendations
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Optional implementation support after findings are accepted
Engagement model: Defined-scope project, typically 60 to 90 days. Fixed fee or contingency-based on captured revenue. Designed to deliver a clear answer the hospital can act on.
Across Facility Revenue Diagnostic engagements at 8 community and regional hospitals, Cigal has reviewed 169,358 annual ED visits and identified $6.75 million in capturable facility-side revenue.
In a separate engagement at an academic medical center with 45,000 annual visits, the diagnostic identified $541,882 in annual capturable revenue from coding, documentation, and acuity gaps.
What Cigal Looks For
Structural misalignment between care delivery, workflow, documentation,
and capture
Revenue and reporting patterns that look normal
but may be
limiting performance
Operational
friction that does not show up
clearly in standard reports
Places where
old assumptions
are still driving current
performance
Once those points are visible, the path forward becomes clear without disrupting the way the organization already operates.
Who We Work With
Practice Stewardship is built for democratic ED partnerships of 5 to 15 physicians at community hospitals. Groups that bill independently, govern themselves, and want a steady, experienced advisor watching the business of the practice without sitting inside it.
Facility Revenue Diagnostics are built for hospital CFOs, ED medical directors, and revenue cycle leaders at community, regional, and academic medical centers who suspect their ED is performing below capacity but cannot pinpoint where.
If you bill both the professional and facility side of the ED, Cigal can examine both inside one engagement.
Start a Conversation
The first conversation is always direct, complimentary, and on your timeline. Sometimes it identifies a clear opportunity. Sometimes it confirms the structure you have is sound. Either outcome is useful.
Or reach Tracy directly at tracy@cigalconcepts.com or (708) 393-7533