Sample report. Figures shown are illustrative and synthetic. Live reports populate from your PointClickCare, MatrixCare, and other clinical and billing feeds.
VBC REPORT 01 · POPULATION · DEMOGRAPHICS
Patient demographics overview
Age, gender, payer mix, and primary psychiatric diagnosis across the network. Value-based contracts price risk on population shape, so this is the baseline every downstream outcome measure is read against.
FY2026 Q2
N=462 · 5 facilities
All facilities reporting
Total patients
462
↑ 14 vs Q4
All facilities
Avg age
74.2 yrs
→ Stable
Geriatric population
Female
58.4%
270 patients
Of total census
Dx documented
98.1%
↑ 0.4pp
Primary psych dx
Age distribution
Nearly three in five patients are 75 or older; acuity and fall risk both track this curve.
55-64
12%
65-74
28%
75-84
38%
85-94
18%
95+
4%
Payer mix
Medicare and Medicaid carry 82% of the census; dual-eligible patients are the highest-touch cohort.
Primary psychiatric diagnosis: top 6
Diagnosis mix drives the acuity and utilization profiles in VBC reports 02 and 04.
Major depression
31%
Dementia + behavioral
24%
Bipolar disorder
16%
Schizophrenia
12%
Anxiety
10%
PTSD / other
7%
Key insight:
The census is geriatric and dementia-weighted: 56% of patients are 75 or older and dementia with behavioral disturbance is the second most common primary diagnosis. Under a value-based contract this combination concentrates risk in falls and behavioral crisis, which is exactly where VBC reports 04 and 07 measure leakage.
Synthetic sample data for illustration. Live value-based care reporting draws from MDS assessments, PointClickCare and MatrixCare clinical feeds, and payer authorization data through the CYBX integration layer.
Sample report. Figures shown are illustrative and synthetic.
VBC REPORT 02 · POPULATION · ACUITY
Primary psychiatric diagnosis prevalence
Diagnosis frequency, monthly trend, acuity tier, and comorbidity patterns.
FY2026 Q2
N=462
6 diagnosis groups
Top diagnosis
Major depression
31% of census
143 patients
Fastest growing
Dementia + behav.
↑ 3.2pp QoQ
111 patients
Comorbidity rate
62.4%
≥2 psych dx
Risk-adjustment driver
Undocumented dx
1.9%
9 patients; gap
Closeable this quarter
Diagnosis prevalence and acuity profile
ER risk is the share of each diagnosis cohort with at least one emergency visit in the quarter.
| Diagnosis | Patients | Acuity | ER risk | Status |
|---|---|---|---|---|
| Major depression | 143 | Moderate | 9.2% | Strong |
| Dementia + behavioral | 111 | High | 11.8% | Watch |
| Bipolar disorder | 74 | High | 14.8% | Watch |
| Schizophrenia | 55 | Very high | 21.4% | High Risk |
| Anxiety disorders | 46 | Moderate | 6.1% | Strong |
| PTSD | 33 | Moderate | 8.4% | Strong |
ER risk by diagnosis cohort
Top co-occurring diagnosis pairs
| Primary + secondary pair | Count | % of primary |
|---|---|---|
| Major depression + anxiety | 68 | 47.6% |
| Dementia + major depression | 54 | 48.6% |
| Bipolar + anxiety | 41 | 55.4% |
| Schizophrenia + substance use | 28 | 50.9% |
| PTSD + major depression | 22 | 66.7% |
| Dementia + anxiety | 19 | 17.1% |
Key insight:
Comorbidity is the story: 62.4% of patients carry two or more psychiatric diagnoses.
Synthetic sample data for illustration.
Sample report.
VBC REPORT 03 · POPULATION · BENCHMARKING
Facility and location performance comparison
Cross-facility benchmarking on census, acuity, PHQ-9 change, gradual dose reduction, and incidents.
FY2026 Q2
5 facilities
Census 462
Top performer
Facility A
PHQ-9 Δ -6.9 pts
Best symptom reduction
Needs attention
Facility B
GDR gap: 38 patients
Documentation shortfall
Network census
462
5 facilities reporting
Complete submission
Data complete
98.1%
↑ 0.4pp vs Q4
Field-level completeness
Cross-facility key metrics: FY2026 Q2
| Facility | Census | Avg acuity | PHQ-9 Δ | GDR % | Incident / 1K | 30-day rdm | Auth note | ER rate | Status |
|---|---|---|---|---|---|---|---|---|---|
| Facility A | 94 | High | -6.9 | 44% | 2.9 | 9.8% | 94% | 7.9% | Strong |
| Facility B | 88 | Very high | -4.1 | 28% | 5.1 | 16.2% | 72% | 23.5% | Watch |
| Facility C | 102 | Moderate | -6.4 | 41% | 3.2 | 11.4% | 88% | 9.8% | Strong |
| Facility D | 91 | High | -6.8 | 39% | 3.8 | 12.1% | 84% | 13.9% | Stable |
| Facility E | 87 | Very high | -5.1 | 31% | 4.7 | 13.8% | 78% | 22.9% | Watch |
Incident rate against GDR documentation
Symptom reduction by facility
Key insight:
Facility B's high incident rate (5.1 per 1,000 resident days) and low GDR documentation (28%) are co-occurring.
Synthetic sample data for illustration.
Sample report.
VBC REPORT 04 · UTILIZATION · AVOIDABLE COST
Avoidable ER visit tracking
Crisis flags, disposition, cost impact, and repeat-visitor risk.
FY2026 Q2
127 ER visits
All facilities
Total ER visits
127
Q1 all facilities
Behavioral and medical
Avoidable visits
18
14.2% of total
Flagged behavioral
Est. avoidable cost
$94K
Q1 attributed
Avoidable ER spend
Repeat ER visitors
31 pts
≥2 visits in Q1
24.4% of visitors
Avoidable visit reasons and facility source
Agitation / aggression
8 visits
Suicidal ideation
4 visits
Medication non-compliance
3 visits
Fall / injury
2 visits
Other behavioral
1 visit
Avoidable share of total ER volume
Repeat ER visitor risk factors
| Risk factor | Repeaters | Non-repeat | Signal |
|---|---|---|---|
| On antipsychotic | 84% | 58% | High |
| Schizophrenia dx | 48% | 19% | High |
| GDR not documented | 71% | 44% | Moderate |
| PHQ-9 >15 at admit | 61% | 38% | Moderate |
| No aftercare plan | 74% | 41% | High |
| Fall risk score >10 | 39% | 28% | Low |
Repeat vs non-repeat prevalence
Key insight:
Absence of an aftercare plan is the single widest gap at 33 points.
Synthetic sample data for illustration.
Sample report.
VBC REPORT 05 · OUTCOMES · DISPOSITION
Discharge outcomes and disposition
Length of stay, discharge reason, acute transfers, and movement to a lower level of care.
FY2026 Q2
All facilities
Discharged cohort
Avg discharge LOS
28.4d
↑ 1.8d QoQ
Discharged to lower LOC
61.2%
↑ 3.1pp QoQ
Acute / ER at discharge
8.4%
↓ 1.2pp QoQ
30-day readmission
11.8%
↓ 1.4pp QoQ
Discharge disposition
Lower level of care
61%
Home / community
18%
Same-LOC transfer
9%
Acute / ER transfer
8%
Deceased
4%
Discharge reason
Goals met
54%
Medically stable
22%
Patient / family request
11%
Acute deterioration
8%
Other
5%
Length of stay at discharge by facility
| Facility | Avg LOS | Acute discharges | Acute rate |
|---|---|---|---|
| Facility A | 31.2d | 3 | 7.9% |
| Facility B | 26.4d | 8 | 23.5% |
| Facility C | 29.8d | 4 | 9.8% |
| Facility D | 28.1d | 5 | 13.9% |
| Facility E | 25.9d | 8 | 22.9% |
Key insight:
Length of stay and acute-discharge rate move in opposite directions: facilities B and E discharge roughly 5 days earlier than A and post acute rates near 23%, against 8% at A.
Synthetic sample data for illustration.
Sample report.
VBC REPORT 06 · OUTCOMES · READMISSION RISK
Discharge detail and 30-day readmission risk
Discharge events by diagnosis, the six-month readmission trend, contributing risk factors, and a ranked patient worklist.
FY2026 Q2
Six-month trend
Top 5 worklist
Discharge detail
| Diagnosis | Avg LOS | ER flag % |
|---|---|---|
| Schizophrenia | 38.2d | 21.4% |
| Bipolar disorder | 31.4d | 14.8% |
| Major depression | 24.8d | 9.2% |
| Dementia + behavioral | 22.1d | 11.8% |
| Anxiety disorders | 18.4d | 6.1% |
30-day readmission rate trend
Readmission risk factors
No aftercare plan
74%
PHQ-9 >15 at discharge
62%
Schizophrenia dx
54%
Prior ER in 90 days
48%
High-risk patient worklist (top 5)
| Patient | Driver | Score | Priority |
|---|---|---|---|
| Pt #4412 | Schizophrenia · 2 prior ER | 98 | Urgent |
| Pt #3871 | Bipolar · GDR failed | 94 | Urgent |
| Pt #5102 | Major depression · PHQ-9: 16 | 81 | High |
Key insight:
Readmission is trending in the right direction, down from 14.2% to 11.8% across six months, but no aftercare plan still leads risk factors at 74%.
Synthetic sample data for illustration.
Sample report.
VBC REPORT 07 · SAFETY · INCIDENTS
Incident reporting dashboard
MDS-sourced incident volume, type, severity, and facility comparison.
FY2026 Q2
214 events
Incidents / 1K resident days
3.8
↑ 0.3 MoM
Total Q1 events
214
State reportable
12
Serious events
High-incident facility
Facility B
5.1 / 1K days
Incident type: Q1 volume
Agitation / aggression
82
Falls
61
Elopement attempt
25
Incident rate by facility
Key insight:
Facility B carries 5 of the network's 12 state-reportable events on 19% of the census.
Synthetic sample data for illustration.
Sample report.
VBC REPORT 08 · SAFETY · PREVENTION AND STAFFING
Fall risk and prevention · staffing metrics
Fall risk scores, intervention outcomes, staffing hours per resident day, and the correlation between the two.
FY2026 Q2
5 facilities
Fall risk score distribution
Low (0-3)
14%
Moderate (4-6)
28%
High (7-10)
38%
Very high (>10)
20%
Intervention effectiveness
| Intervention | Fall rate Δ |
|---|---|
| Bed alarm protocol | -38% |
| Low bed + mat | -29% |
| No intervention documented | +12% |
Staffing hours per resident day
| Facility | Total hrs | Status |
|---|---|---|
| Facility A | 4.2 | Good |
| Facility B | 3.2 | Low |
| Facility E | 3.0 | Low |
Staffing tier against incident rate
Key insight:
The staffing gradient is close to linear: every step down in nursing hours adds roughly 1.5 incidents per 1,000 resident days.
Synthetic sample data for illustration.
Sample report.
VBC REPORT 09 · REVENUE INTEGRITY · COMPLIANCE
Authorization and timely filing compliance
Authorization approvals, denial reasons, timely filing by payer, and revenue at risk.
FY2026 Q2
5 payers
$142K at risk
Auth approval rate
88.4%
↑ 1.8pp QoQ
Auth note completion
84.7%
↓ 0.4pp
Timely filing rate
96.2%
↑ 0.9pp QoQ
Revenue at risk
$142K
Open denials
Authorization denial reasons
Not medically necessary
38%
Missing clinical documentation
29%
Auth note completion by facility
Facility A
94%
Facility B
72%
Timely filing by payer
| Payer | Window | Rate | Status |
|---|---|---|---|
| Medicare | 12 months | 99.1% | Strong |
| Aetna | 90 days | 84.8% | At Risk |
| UnitedHealth | 90 days | 82.1% | At Risk |
Filing compliance against window length
Key insight:
Timely filing tracks window length almost exactly: 12-month payers clear above 97% while the two 90-day payers sit in the low 80s.
Synthetic sample data for illustration.
Sample report. Figures shown are illustrative. Live reports populate from your practice management, EHR, and clearinghouse feeds.
FFS REPORT 01 · DENIALS · ROOT CAUSE
Avoidable vs unavoidable denials
Two-thirds of FFS denials are preventable if you catch them upstream. CYBX classifies every denial by root cause and tells you where in the workflow to fix it.
Last 90 days
Practice: Lakeside Health (sample practice)
14 clinicians · $9.8M annualized
Total denials
$487K
+12% vs prior 90d
Avoidable
$361K
74% of denials
Prevented this period
$94K
CYBX upstream catches
Unavoidable
$126K
payer + medical necessity
Denials by root cause
Avoidable bucket is fixable through process and AI. Unavoidable bucket feeds payer renegotiation.
AVOIDABLE 75%
UNAVOIDABLE 25%
Where to fix it
Each avoidable bucket maps to a specific workflow shift.
01
Eligibility / VOB error · 28%
Catch at intake. Real-time eligibility check before scheduling.
02
Missing or expired auth · 19%
Concurrent review countdown. Alerts 14 days before expiry.
03
Modifier or POS mismatch · 13%
AI flag on submission. Telehealth modifier audit (Report 03).
04
Untimely filing · 8%
Notes-not-locked aging triggers escalation to clinician.
05
Coding / documentation · 7%
Pattern detection on prior denials. Pre-submission flag.
Top denials by payer + root cause
Click any row to drill to claim-level detail. Action column drives the billing manager's worklist priority.
| Payer | Root cause | Bucket | Claims | Dollars | Recommended action |
|---|---|---|---|---|---|
| Aetna Commercial | Eligibility / VOB error | Avoidable | 87 | $54,210 | Intake VOB process review |
| BCBS PPO | Missing or expired auth | Avoidable | 62 | $41,880 | Auth tracker auto-alerts |
| UHC Optum BH | Modifier or POS mismatch | Avoidable | 119 | $37,605 | Telehealth audit (Report 03) |
| Cigna Behavioral | Medical necessity | Unavoidable | 28 | $22,440 | Appeal + parity evidence |
| Medicaid (state) | Untimely filing | Avoidable | 71 | $18,920 | Notes-not-locked escalation |
| Aetna Commercial | Retroactive eligibility term | Unavoidable | 15 | $11,250 | Patient outreach + write-off |
Key insight:
75 percent of denial dollars are sitting in the avoidable bucket. Fixing the top three root causes (eligibility, auth, modifiers) recovers an estimated $133K per quarter without touching the appeals queue.
Sample data shown for illustration. Benchmarks: AMA, PIMSY, BillingParadise, MGMA. CYBX classification model trained on practice-specific denial history plus published payer remit code patterns.
Sample report. Figures shown are illustrative. Live reports populate from your practice management, EHR, and clearinghouse feeds.
FFS REPORT 02 · DENIALS · RECOVERY ECONOMICS
Cost-to-collect per denied dollar
When working a denial costs more than recovering it, the math says write off. CYBX makes the call explicit by claim, by payer, by dollar size.
Last 90 days
Practice: Lakeside Health (sample practice)
2,847 denied claims this period
Avg cost per recovered $
$0.37
$0.50 = write-off threshold
Denial recovery rate
62%
+8 pts vs baseline
Recovered this period
$215K
on $361K avoidable
Smart-write-off saved
$28K
staff time redirected
Claims by dollar size vs work effort
Above the dashed line, work the claim. Below, write off. Threshold tunable per payer.
This week's recommendation
Math-driven triage for the billing manager.
Work these claims
412 claims
$184,200 expected recovery at avg $0.31 cost-to-collect.
Write off
237 claims
$8,940 face value at avg $0.71 cost-to-collect.
Threshold by payer
| Payer | Threshold | Recovery rate |
|---|---|---|
| Aetna Commercial | $0.42 | 71% |
| BCBS PPO | $0.38 | 68% |
| UHC Optum BH | $0.51 | 54% |
| Cigna Behavioral | $0.45 | 61% |
| Medicaid (state) | $0.62 | 42% |
Key insight:
Smart triage redirects staff time from low-margin small claims to the high-yield avoidable bucket. Net effect: recovery rate climbs while total recovery cost falls.
Sample data shown for illustration. CYBX recommendation engine factors: avg appeal cycle time per payer, historical reversal rate by denial code, billing manager hourly fully-loaded cost. Calibration: MGMA "Beyond Days in A/R", HFMA cost-to-collect benchmarks.
Sample report. Figures shown are illustrative. Live reports populate from your practice management, EHR, and clearinghouse feeds.
FFS REPORT 03 · PREVENTION · TELEHEALTH
Telehealth modifier and POS audit
Place of service 02 vs 10 swings $58 per visit. Modifier 95 vs 93 plus state parity rules drive 30 to 40 percent of telehealth claim failures. CYBX flags every mismatch before submission.
Last 30 days
Practice: Lakeside Health (sample practice)
1,824 telehealth claims audited
Mismatches detected
183
10% of telehealth volume
$ at risk
$10.6K
avg $58/visit on POS
Caught pre-submission
156
85% prevention rate
Recovered post-denial
$8.2K
26 claims, modifier appeal
Modifier compliance by payer
Heat map of compliance rate per payer per modifier rule. Red cells are payer-specific gotchas that CYBX flags pre-submission.
PAYER
POS 10 home
POS 02 elsewhere
Mod 95 A/V
Mod 93 audio
State parity
Aetna Commercial
98%
96%
99%
71%
94%
BCBS PPO
95%
68%
97%
89%
73%
UHC Optum BH
42%
61%
93%
38%
58%
Cigna Behavioral
91%
88%
94%
76%
90%
Medicaid (state)
74%
86%
95%
88%
44%
85% or above
50-84%
Below 50%
Open mismatches this week
Worklist for the billing manager. CYBX has staged the corrected submission for review.
| Date | Patient ID | Clinician | Payer | Detected issue | $ at risk | CYBX recommendation |
|---|---|---|---|---|---|---|
| Apr 28 | PT-4821 | Dr. Mehta | UHC Optum BH | POS 02 used, patient at home | $58 | Resubmit POS 10 |
| Apr 28 | PT-3047 | L. Park, LCSW | BCBS PPO | Mod 95 on audio-only session | $112 | Change to Mod 93, resubmit |
| Apr 27 | PT-5892 | Dr. Mehta | UHC Optum BH | Audio-only without Mod 93 | $112 | Add Mod 93, resubmit |
| Apr 26 | PT-2113 | R. Daniels, LMFT | Medicaid (NY) | State parity rule: in-state requirement | $84 | Verify provider state license |
| Apr 25 | PT-4109 | L. Park, LCSW | Aetna Commercial | Mod 93 on synchronous session | $96 | Change to Mod 95, resubmit |
Key insight:
UHC Optum BH compliance is the largest exposure: POS 10 at 42% and Mod 93 at 38%. Targeted training plus pre-submission rule overlay closes the gap before submission.
Sample data shown for illustration. Sources: CMS Telehealth FAQ Feb 2026, CY2026 PFS final rule. State parity rules tracked across all 50 states with payer-specific overlays. CYBX rule library updates monthly.
Sample report. Figures shown are illustrative. Live reports populate from your practice management, EHR, and clearinghouse feeds.
FFS REPORT 04 · ENGAGEMENT
Intake-to-engagement funnel
Most dashboards stop at no-show rate and miss the funnel above and below it. Of 100 inquiries, only 20 stay active at 90 days. Marketing spend and capacity decisions ride on this view.
Last 90 days
Practice: Lakeside Health (sample practice)
342 new inquiries this period
Inquiries
342
+18% vs prior 90d
Intake completed
178
52% conversion
First treatment session
119
35% of inquiries
Active at 90 days
71
21% (vs 20% benchmark)
Funnel
Industry benchmark: 100 / 50 / 33 / 20. Lakeside is performing slightly above benchmark on intake conversion, slightly below on first-session conversion.
Inquiries
342
52% intake conversion (benchmark 50%)
Intake (90791)
178
67% to first session (benchmark 66%)
First treatment session
119
60% retention to 90 days (benchmark 60%)
Active at 90 days
71
Where dropoff is happening
Days from inquiry to next stage. Long waits drive dropoff.
Conversion by referral source
Drives marketing spend allocation. CYBX attributes inquiries through admission and computes cost-per-active-patient by channel.
| Referral source | Inquiries | Intake | First session | Active 90d | End-to-end conv. | Status |
|---|---|---|---|---|---|---|
| Direct PCP referral | 94 | 61 | 48 | 31 | 33% | Strong |
| EAP partner (Lyra) | 71 | 52 | 39 | 18 | 25% | On-benchmark |
| Self-referral / web | 88 | 31 | 15 | 9 | 10% | Investigate |
| Payer directory | 43 | 19 | 11 | 7 | 16% | Below avg |
| Existing patient referral | 31 | 11 | 5 | 5 | 16% | Small sample |
| Court / court-ordered | 15 | 4 | 1 | 1 | 7% | Reassess |
Key insight:
Self-referral / web is the largest inquiry source but the weakest converter. Speed-to-lead automation closes the gap; expect a 2x improvement on intake conversion within 30 days of activation.
Sample data shown for illustration. Benchmarks: Hamm Clinic Attrition in Psychotherapy survival analysis, APA dropout meta-analysis, Mend BH no-show research.