Lender Intelligence — DRL Holdings

DRL Holdings Intelligence · Workbook v1.3

Design Principles Built In

A production risk system covering financial, operational, clinical, staffing, regulatory, documentation, case-mix / PDPM, deterministic stress, Monte Carlo, survey/audit probability, and facility/REIT valuation — in one workbook that works for any facility. Consistent product language: Evidence-only · Flat-fee · BAA-first.

Workbook design principles
Principle	Practice
Yellow cells = inputs	Editable fields use yellow fill and blue text. Do not overwrite green or black formula cells.
Live Excel formulas	Ratios, scores, gaps, and stress results recalculate when inputs change.
Cross-sheet links in green	Green text pulls from other sheets (Dashboard ← inputs; Monte Carlo ← financials; Survey/Audit ← staffing, documentation, case-mix).
Documentation / hidden-revenue layer is first-class	Sheet `06_Documentation_Risk` plus Case-Mix & PDPM engine on sheet 12 — not footnotes.
Works for any facility	Duplicate the file per building or deal. Portfolio comparison on sheet 11.
Evidence-only · Flat-fee · BAA-first	Branded on cover and dashboard. Compatible with DRL Holdings Intelligence methodology.
Deterministic + probabilistic stress	Twelve lender/actuary scenarios on sheet 08; Monte Carlo on sheet 13; survey/audit probability on sheet 14; valuation on sheet 15.

Color legend · yellow + blue = input · green = cross-sheet link · black = formula · traffic lights = Low / Moderate / High

Sample loaded

Demo facility — Example Care Center of Springfield

Open sheets 07–09 and 12–15 to see scores, case-mix gaps, stresses, probabilistic DSCR, survey/audit probabilities, and valuation immediately.

Demo profile (modeled)
Item	Value
Facility	Example Care Center of Springfield · 120 beds · IL · freestanding
Occupancy / payer	~82% occupancy · Medicare ~26% of NPR · Medicaid ~52% of NPR
Labor / quality	Agency labor ~18% · nursing turnover ~48% · 3-star overall · no Immediate Jeopardy
Chart sample	n = 48 · ~$620k annualized documentation opportunity · ~$140k annualized audit exposure
Scores	Opportunity Score 68 · Documentation Risk Score 42 · composite risk in the Moderate band
Monte Carlo (illustrative 1,000 trials)	Mean DSCR ~1.52x · ~11% probability of breach below 1.20x · ~4% chance of DSCR < 1.00x
Survey / audit (next 12 mo)	~39 risk points · uplift ~1.39× · standard survey ~46% (ELEVATED) · any survey/audit ~64% — moderate, not extreme
Valuation (Sheet 15)	EV ~$17.0M reported / ~$19.6M with doc upside (base) · EBITDAR/Rent ~3.15x · EV/bed ~$163k with upside

Sheet 12

Case-Mix & PDPM Engine

Neutral rate vs observed CMI vs peer CMI, automatic gap calculations, implied under-documented intensity, dollar impact of closing the CMI gap, and component-level PDPM analysis linked to chart count.

What sheet 12 calculates
Block	Outputs
A–C · Inputs, gaps, $	Neutral / observed / peer CMI · gap points · $/0.01 point · annualized opportunity from closing the neutral gap.
D · PDPM components	PT/OT, SLP, Nursing, NTA, Section GG, secondary diagnosis — gap % × $ / chart × sample size.
E–F · Flags & Leak %	Material under-capture · below-peer CMI · high GG incompleteness · Quick Leak % → $ next to CMI Gap $.
G · CMI Excel formulas	Copy-paste AVERAGE / SUM÷COUNTA · live component CMI table (PT–NTA) · Observed vs Neutral gap & gap % · formula summary block.

Methodology · Sheet 12

How to calculate Case Mix Index (CMI)

CMI is a single number that reflects the average clinical complexity—and therefore expected resource use / payment intensity—of the patients in a facility over a period. Live Excel formulas ship in Sheet 12 → Section G.

Basic formula
Form	Equation
CMI	Σ (Case-Mix Weight of each patient stay) ÷ Number of patient stays
In plain English	Add up the payment weight of every stay, then divide by the number of stays. The result is the average weight.
CMI Gap	Observed CMI − Neutral (or Peer) CMI

Excel formulas (Sheet 12 · Section G)

Core formulas are ready to copy from the workbook summary block. Component CMI rows calculate automatically when you enter Sum of Weights and Number of Stays.

Core CMI formulas — copy / paste
#	Purpose	Excel
1	Simple average of stay-level weights	`=AVERAGE(weight_range)` Example: `=AVERAGE(H2:H101)`
2	Equivalent using SUM / COUNT	`=SUM(weight_range)/COUNTA(weight_range)`
3	Component CMI (PT, OT, SLP, Nursing, or NTA)	`=Sum_of_Component_Weights / Number_of_Stays` Live in workbook: `=IF(C57=0,"",B57/C57)`
4	CMI Gap (points)	`=Observed_CMI - Neutral_CMI`
5	CMI Gap as % of neutral	`=(Observed_CMI - Neutral_CMI) / Neutral_CMI`

Where to find them — Sheet 12 · CaseMix_PDPM → Section G
Block	What it does
Method 1	Simple average formula (`AVERAGE` or `SUM/COUNTA`) when you have a list of stay-level weights.
Method 2	Component-level table — enter Sum of Weights + Number of Stays for PT / OT / SLP / Nursing / NTA; Component CMI calculates automatically.
Method 3	Observed vs Neutral gap — linked to the inputs already on the sheet (gap pts and gap %).
Summary	All five core formulas listed as copy-paste text at the bottom of Section G.

Under PDPM — what drives each component weight
Component	What drives the weight
PT	Clinical category + Section GG function score
OT	Clinical category + Section GG function score
SLP	Neurologic / cognitive / swallowing conditions
Nursing	Extensive services, clinical conditions, depression, restorative, function
NTA	Non-therapy ancillary comorbidities (scored by points)

CMS publishes a relative weight for every possible group in each component. Facility CMI is effectively the average of those weights across Medicare Part A stays (sometimes reported as a combined or nursing-focused index).

Practical ways to calculate CMI
Path	How
1. MDS / claims (most accurate)	Pull every Medicare Part A stay → look up PDPM groups for PT, OT, SLP, Nursing, and NTA → convert to CMS relative weights → average.
2. Facility / EMR reports	Many systems already display Average CMI, PDPM Nursing Index, or Case-Mix Index – Medicare.
3. Neutral / expected CMI	Compare observed CMI to CMS/state neutral or peer average. Negative gap → under-capture; positive gap → higher-than-expected intensity.

Simple example (illustration)
Stay	Nursing weight	PT/OT weight
1	1.20	1.45
2	0.95	1.10
3	1.55	1.70
Average (CMI)	1.23	1.42

Facility CMI ≈ 1.23–1.42 depending on which index is reported. If the facility’s neutral rate is 1.42 and observed Nursing CMI is only 1.23, the gap is −0.19 points—exactly what Sheet 12 converts into a dollar opportunity.

A CMI gap of roughly 0.08–0.15 points below neutral often translates into a 4–8% Medicare revenue shortfall—why Leak % and CMI Gap $ sit next to each other on Sheet 12. Prefer NPR: Revenue Leak $ = NPR × Leak %.

Open Sheet 12 · Section G Excel formulas Leak % → $ Driver Card

Sheet 13

Monte Carlo Stress Test Analysis — Demo Facility

Probabilistic DSCR and margin risk for lenders and PE. Base case is linked; driver distributions are editable; illustrative 1,000-trial results ship with the demo facility on Sheet 13_Monte_Carlo.

Base case snapshot
Metric	Value
Base Revenue	$14.5M
Base EBITDA	$1.55M
Base Debt Service	$980k
Base DSCR	1.58x

Starts from a reasonably comfortable position (above the common 1.20–1.25x lender floor).

Simulation results (1,000 trials)
Statistic	DSCR	EBITDA
Mean	1.52x	$1.49M
Median	1.54x	$1.51M
75th percentile	1.68x	$1.65M
25th percentile	1.35x	$1.32M
10th percentile	1.18x	$1.16M
5th percentile (tail)	1.05x	$1.03M
95th percentile	1.95x	$1.91M
Std. Deviation	0.22x	$215k

Probabilities
Event	Probability
DSCR < 1.20x (covenant breach zone)	~11%
DSCR < 1.00x (cannot cover debt service from EBITDA)	~4%

What the distribution tells us
Insight	Reading
Central tendency	Mean/median DSCR (1.52–1.54x) sit only modestly below the 1.58x base. Under average draws, the facility still clears typical covenant floors.
Left tail	10th percentile DSCR 1.18x (at/just under a 1.20x floor). 5th percentile 1.05x — coverage is thin; further shock or cash timing becomes dangerous.
Volatility	σ of 0.22x on DSCR is meaningful but not chaotic. Mass of the distribution remains above ~1.3x.
Asymmetry	Drivers centered near zero or slightly negative (esp. triangular Medicaid with a negative mode) → mild left skew.

Driver sensitivity (qualitative ranking)
Driver	Relative importance	Notes
Revenue / Occupancy shocks	High	Largest swing factor — SNF cost structures are largely fixed.
Labor / Agency cost spikes	High	Direct EBITDA hit; agency is already ~18% of labor.
Medicaid rate changes	Medium–High	~52% of revenue is Medicaid — rate cuts bite hard.
Other OpEx	Lower	Smaller assumed volatility.

A Medicaid rate cut + occupancy softness is what most often pushes trials into the sub-1.20x zone.

Credit / investment interpretation
Lens	Reading
Lender	Base DSCR 1.58x is acceptable. ~11% chance of testing 1.20x is elevated but not extreme for the sector. ~4% chance of DSCR < 1.0x argues for cushion (reserve, springing guarantee, or tighter monitoring).
Operator / Owner	Can absorb normal volatility. Danger zone is simultaneous pressure on census/rates and labor. Documentation upside ($620k) improves the buffer if realized.
REIT / NNN	Rent coverage on reported EBITDAR ~3.15x — very strong. Even at 5th-percentile EBITDA (~$1.03M), coverage would still be ~1.4x on the current $720k rent.
PE / Acquirer	Moderate risk — not a “cliff,” but downside scenarios are plausible enough to matter in underwriting and the multiple paid.

Link to the rest of the workbook
Connection	Detail
Sheet 08 Stress	Deterministic shocks (Medicaid −5%, occupancy −5 pts, agency spike, staffing-rule cost) individually push DSCR below 1.20x — confirmed inside the Monte Carlo left tail.
Documentation opportunity	Clearest internal lever: raising EBITDA by even $300–400k (half the identified leak) shifts the DSCR curve up and shrinks breach probability.
Composite risk 40.6	Consistent with an ~11% covenant-breach probability — neither low-risk nor distressed.
Sheet 15 Valuation	Middle-of-range multiples fit this profile; doc upside is the clearest path to thicken the cushion.

Bottom line: not fragile in the base case, but exposed in the left tail — roughly 1 in 9 simulated years tests a 1.20x floor; roughly 1 in 25 years produces EBITDA that cannot fully cover debt service. Results remain live and linked on Sheet 13_Monte_Carlo. Change driver distributions or base financials and this framework still applies.

Open Sheet 13 Valuation Survey / audit Documentation upside

Sheet 14

Survey & Audit Probability Model

Transparent, additive risk-score model estimating the probability of a standard or complaint state survey or a Medicare audit (medical review) in the next 12 months. Every factor is linked and defendable to a lender, operator, or buyer.

Step 1 — Risk points (triggered by clear thresholds)
Factor	Points if triggered
Immediate Jeopardy (last 3 yrs)	+25
G-level+ tags (≥2)	+12
High deficiency count	+4 to +10
Infection Control citation	+6
1-Star overall	+15
High agency labor (≥20–25%)	+10 to +12
High turnover (≥50–60%)	+8 to +10
Documentation Risk Score ≥50–60	+5 to +15
High Opportunity Score (≥70)	+6
Large CMI under-capture	+5 to +8

Steps 2–4 — Core formulas (Sheet 14 · Section E)
Step	Excel
2 · Uplift Factor	`=1 + (Total_Points / 100)` 100 points ≈ 2× the base probability
3 · Adjusted Probability	`=MIN(cap, Base_Rate × Uplift_Factor)`
4 · Any Event (approx. union)	`=1 - (1 - P_standard) × (1 - P_complaint) × (1 - P_audit)`

What Sheet 14 produces
Section	Content
A · Base rates	Editable industry starting points for standard survey, complaint survey, and Medicare audit.
B · Risk multipliers	Auto-linked from Sheets `05`, `06`, and `12` — points + multipliers per factor.
C · Totals	Total Risk Points and Probability Uplift Factor.
D · Probabilities	Four probabilities + risk bands (BASELINE / ELEVATED / HIGH).
E · Formula summary	Copy-paste ready model formulas.

Demo facility — Example Care Center of Springfield
Signal	Value
Profile	No IJ · moderate deficiencies · 3-star · agency ~18% · Doc Risk 42 · CMI gap −0.11
Total risk points	~39
Uplift factor	~1.39×
Standard survey (12 mo)	~46% · ELEVATED
Complaint survey	~25% · ELEVATED
Medicare audit / medical review	~11% · BASELINE
Any survey or audit	~64% · ELEVATED

Elevated relative to pure base rates, but not extreme — matches a moderate documentation and survey-history profile. Recalibrate Section A base rates for state-specific experience. Model is directional; not a substitute for state survey schedules or CMS selection algorithms.

Open Sheet 14 Demo profile Workbook overview

Sheet 15

Facility & REIT Valuation — Demo Facility

All figures are driven by the workbook (EBITDAR, risk scores, documentation opportunity, and sector multiples). Editable multiples, risk adjustment, and documentation premium recalculate EV, equity, and REIT coverage automatically.

1. Core financial anchors
Metric	Value
Total Operating Revenue	$14.5M
EBITDAR	$2.27M
EBITDA	$1.55M
Long-Term Debt	$5.1M
Beds / Occupancy	120 · ~82%
Composite Risk Score	40.6 (Moderate)
Annualized Hidden Revenue	$620k (~4.4% leak)

2. Enterprise Value (EBITDAR method) — adjusted multiples ~5.9x / 7.5x / 9.6x
View	Low	Base	High
Reported EBITDAR only	$13.4M	$17.0M	$21.8M
With documentation upside (40–70% of $620k)	$14.9M	$19.6M	$26.0M
Equity Value (EV − $5.1M debt, with upside)	$9.8M	$14.5M	$20.9M
EV per Bed (with upside)	$124k	$163k	$216k

Base 7.5x, modest risk discount for the moderate composite score, modest premium for credible documentation upside.

3. REIT / NNN-style view
Metric	Value	Comment
Current Rent	$720k	From financials
EBITDAR / Rent coverage	3.15x	Strong (REITs often want 1.3–1.5x+)
Implied sustainable rent at 1.4x	~$1.62M	On reported EBITDAR
Implied rent with doc upside	~$1.87M	If hidden revenue is realized (base)
Property value at 7.5% cap on current rent	$9.6M	Pure NNN rent-stream view

4. What the numbers mean
Point	Takeaway
As-is	Value clusters around $15–18M enterprise for a moderate-risk, 120-bed freestanding SNF with solid DSCR (~1.58x) and healthy rent coverage.
With doc upside	Base case rises to roughly $19–20M EV — about +$2.5M vs reported-only (more if a buyer underwrites a higher realization rate).
Differentiator	A 4.4% chart-supported revenue leak with only moderate audit risk is exactly the value lever DRL Holdings Intelligence is built to quantify.
Risk cap	Monte Carlo still shows ~11% chance of DSCR < 1.20x under stress — keeping the multiple off the very top of the range.

Where to find it: Sheet 15_Valuation — linked inputs, editable multiples / risk adjustment / documentation premium, full low–base–high EV and equity ranges, REIT coverage and implied property value. Decision-support range, not an appraisal.

Open Sheet 15 Leak % → $ Survey / audit

Chart review focus · Components 1 & 2

PDPM Component Drivers — PT/OT and SLP

Under PDPM, these two therapy-related components are among the most common sources of both under-documented revenue and audit exposure. Sheet 12 now splits PT/OT into GG vs diagnosis sub-drivers and requires an Evidence Strength flag on every row.

PT/OT — what drives the payment group
Driver	Detail
Clinical category	Primary reason for SNF stay — specificity matters.
Section GG	Self-care + mobility functional score — direct input to the PT/OT CMG.
Comorbidities / surgical history	Map to higher payment groups when documented and active.

PT/OT — frequent gaps
Gap	Typical $ / stay	Chart pattern
Incomplete / conservative Section GG	$80–$250+	Missing items, “activity not attempted” overused, scores ≠ therapy notes
Therapy notes not linked to MDS	$100–$300	Notes exist but MDS/GG too generic or blank
Primary diagnosis lacks specificity	$150–$400	“Aftercare” or symptom codes instead of underlying condition
GG not reassessed on schedule	Variable	Late or missing look-back assessments

SLP — frequent gaps
Gap	Typical $ / stay	Chart pattern
Swallowing / diet texture not clear	$70–$200	Diet orders exist; MDS blank or “no”
Cognitive impairment under-coded	$50–$180	Nursing describes confusion; BIMS incomplete
SLP eval not in MDS	$80–$220	Therapy notes present; MDS SLP items blank
Neurologic dx buried in history	$100–$300	CVA / Parkinson’s not primary or secondary

Score linkage
Pattern	Effect
High PT/OT + SLP opportunity (Partial / Strong)	Raises Revenue Opportunity Score
Unsupported SLP or aggressive GG (Weak / Missing)	Raises Documentation Risk Score

Open Driver Card Workbook · Sheet 12 Case-Mix engine

Formula · Lender conversations

Revenue Leak % → $

Convert a documentation-opportunity percentage into annual dollars. Most operators and lenders prefer Net Patient Revenue as the base.

Core formulas
Form	Equation
Preferred	Revenue Leak ($) = Net Patient Revenue × Leak %
Alternate	Revenue Leak ($) = Total Operating Revenue × Leak %
From chart review	Observed Leak % = Annualized Opportunity $ ÷ Net Patient Revenue

Demo facility (NPR $14,200,000 · TOR $14,500,000)
Base	Amount	4% Leak	6% Leak	8% Leak
Net Patient Revenue	$14,200,000	$568,000	$852,000	$1,136,000
Total Operating Revenue	$14,500,000	$580,000	$870,000	$1,160,000

For this facility, a 4–8% revenue leak equals roughly $570k – $1.14 million per year. Observed chart-review leak: $620,000 ÷ $14,200,000 ≈ 4.4%.

Planning band (when you don’t yet have a full chart sample)
Leak %	Meaning
4%	Conservative / lower-bound opportunity
6%	Typical mid-range finding in many SNFs with documentation gaps
8%	Upper end when GG, diagnosis specificity, and NTA are all weak

Quick reference — any facility (NPR base)
Net Patient Revenue	4% Leak	6% Leak	8% Leak
$8,000,000	$320,000	$480,000	$640,000
$12,000,000	$480,000	$720,000	$960,000
$14,200,000 (demo)	$568,000	$852,000	$1,136,000
$18,000,000	$720,000	$1,080,000	$1,440,000
$25,000,000	$1,000,000	$1,500,000	$2,000,000

In the workbook: Sheet 06_Documentation_Risk (full calculator + quick reference) and Sheet 12_CaseMix_PDPM (compact linked block next to CMI Gap $). Yellow Leak % cells update dollars automatically. A CMI gap of ~0.08–0.15 points below neutral often maps to this 4–8% band — see How to calculate CMI.

Open calculator in workbook Workbook overview

Immediate use

How to Use Immediately

Download both files. Open the Excel workbook to see the demo calculated; use the PDF for core sheet-by-sheet workflow.

Recommended workflow
Step	Action
1	Open the file (demo already loaded).
2	Review `07_Risk_Scores`, `08_Stress_Scenarios`, `09_Dashboard`, then `12`–`15` (Case-Mix, Monte Carlo, Survey/Audit, Valuation).
3	For a live deal: duplicate the file, then fill yellow cells on `02` → `03` → `04` → `05` → `06` → `12`.
4	Adjust category scores on 07 if judgment differs from pure formula signals.
5	Note which of the 12 shocks on 08 break the 1.20x DSCR floor; read breach probabilities on 13.
6	For portfolios, copy outputs into `11_Portfolio_Summary`.

Thirteen sheets
Sheet	What you do
`01_Cover_Instructions`	DRL Holdings Intelligence branding, color key, data sources.
`02_Facility_Profile`	Identity, beds, ownership, analysis purpose.
`03_Financial_Inputs`	Cost-report / internal financials + multi-year trend notes.
`04_Operational_Inputs`	Occupancy, payer mix, census, referrals.
`05_Staffing_Quality`	HPPD, turnover, stars, readmissions, deficiencies, CMPs.
`06_Documentation_Risk`	Chart sample, opportunity $, audit exposure $, scores.
`07_Risk_Scores`	Six weighted categories → Composite Risk Score + traffic lights.
`08_Stress_Scenarios`	Twelve deterministic stresses → stressed DSCR Pass/Fail.
`09_Dashboard`	Executive one-page summary (auto-linked; branded).
`10_Benchmarks`	Industry reference values (distressed / median / strong).
`11_Portfolio_Summary`	Side-by-side multi-facility comparison.
`12_CaseMix_PDPM`	Case-mix gaps, PDPM components, CMI Excel formulas (Section G), Leak % ↔ CMI Gap $.
`13_Monte_Carlo`	Driver distributions + illustrative probabilistic DSCR results.
`14_Survey_Audit_Prob`	12-month survey & Medicare audit probabilities — risk points, uplift, BASELINE/ELEVATED/HIGH bands.
`15_Valuation`	Facility EV / equity (EBITDAR multiples) + REIT/NNN rent coverage and implied property value; documentation upside scenarios.

Twelve stress scenarios (sheet 08)
#	Scenario
1–2	Medicaid rate cut −5% / −10%
3–4	Occupancy drop −5 / −10 pts
5–6	Agency labor spike · combined revenue + labor
7	Custom user stress (edit yellow cells)
8	Medicare rate cut −3%
9	Medicaid payment delay
10	Minimum staffing rule compliance cost
11	Dual policy shock (Medicaid cut + staffing rule)
12	Severe occupancy drop (−15 pts)

Composite weights (sheet 07 — calibrate to credit policy)
Category	Weight
Financial / Credit	25%
Occupancy & Payer Mix	15%
Staffing & Labor	15%
Quality & Clinical Outcomes	15%
Regulatory / Survey	10%
Documentation / Revenue Integrity	20%

Download workbook (.xlsx) Download user guide (.pdf) PDPM Driver Card Pull CMS profile

When ready for a real facility, clear the yellow input cells (or duplicate the file) and start fresh. Keep the Modeled basis label until verification under BAA. Canonical workbook file: sites/drlholdings/assets/DRL_Holdings_SNF_Risk_Workbook.xlsx.

Public data · Live CMS

Facility lookup

Search any skilled nursing facility by CMS Certification Number or name and receive the facility’s public Medicare profile — ratings, census, ownership, staffing, enforcement history, fine exposure, and cost-report financials — assembled live from CMS Care Compare and the SNF Cost Report public use file. Public data only; no facility records, no PHI.

Scope

What the assessment covers

Traditional diligence emphasizes financials and survey history. This assessment reads the clinical chart the way an auditor does, so collateral quality and recovery potential can be evidenced before transition closes.

Defined outputs
Output	Definition	Status label
Opportunity estimate	Supported diagnoses or services present in notes but missing or under-documented relative to billed capture, expressed as sample dollars and an annualized facility estimate with confidence range.	Modeled → Verified after sample QC
Audit exposure estimate	Documentation that is weak or contradictory relative to what was billed, expressed on the same bases.	Modeled → Verified after sample QC
Score summary	Revenue Opportunity Score and Documentation Risk Score (0–100), derived from the same quantified gaps.	Methodology Card v1.1
Evidence package	Findings cited to note type, date, and author string. Nothing is invented.	Evidence only

Process

Credit-process sequence

Every engagement follows the same mandatory sequence. Deviations are documented before delivery.

Methodology Card · mandatory sequence
Step	Action	Artifact
1. Intake	Confirm BAA. Log facility, EMR, date range, sample size, project ID.	Project Intake Log
2. Extraction	Pull only what already exists on the chart; map to standard template.	Standardized Data File
3. Dual Review	Clinical review + coding/revenue review. Count only documented opportunities.	Annotated Findings Log
4. Quantification	Sample gap dollars and annualized estimate with confidence range. Opportunity $ separate from Audit Exposure $.	Gap Calculation Sheet
5. Scoring	Assign Revenue Opportunity Score and Documentation Risk Score (0–100).	Score Summary
6. Packaging	Translate findings into the lender risk memo format.	Final Report + Evidence Package
7. QC & Delivery	Second review for methodology adherence. Deliver report + source evidence.	Signed-off Deliverable

Report template carries Report ID, generation date, and Methodology v1.1 — see Disclosures on every page. Screen and PDF share one visual system.

Illustrative only

Worked example (modeled)

The figures below illustrate how a supported code already on a chart can map through a diligence path. They are not a payment guarantee and are not facility-specific until verified under BAA.

Modeled screening

I50.22 path · chronic systolic heart failure
Layer	Indication	Figure
Supported code	I50.22 — Chronic systolic (congestive) heart failure, where the note supports specificity	—
Stay-level delta	The model indicates an illustrative per-day differential when specificity is captured versus omitted	$24 / day
Annualized run-rate	We estimate $24 × 365 as a simple annualization for illustration	$8,760 / year
Enterprise context	Underwriting may consider documentation-backed cash flow and audit exposure when forming a view of collateral quality	See diligence memo

Counterparties

Who commissions this work

Typical commissioning parties
Party	Use of the memo
Lenders & special servicers	Collateral documentation quality and recovery potential under stress — evidence for credit judgment, not a lending decision.
Receivers & interim managers	Week-one baseline of documentation-backed opportunity and audit exposure after takeover.
Creditors’ committees & counsel	Cited findings suitable for committee and court context; flat-fee engagement structure.

Guardrails

Commercial and compliance posture

Non-negotiable terms
Term	Practice
Fee structure	Flat fee by bed count or engagement scope. No percentage of recovery.
PHI	Business Associate Agreement required before any PHI is accessed.
Evidence rule	Only opportunities already documented on the chart are counted. Nothing invented.
Decision support	Findings do not constitute coding, legal, or compliance advice. Facility clinicians validate before billing changes.
Facility isolation	Each building’s chart remains its own across engagements.

Formal treatment of no-reliance language, methodology limitations, and the modeled-versus-verified distinction appears on the Disclosures page. Conflicts posture is published under Conflicts policy.

Firm materials

Page	Purpose
Insights	Dated, bylined notes on methodology, validation, and chart anatomy.
People	Principal biography and credentials.
Disclosures	Terms, limitations, modeled-vs-verified, conflicts.
Client Access	Portal entry for authenticated counterparties.