Map medical lease costs
Give lease costs their own part of the margin review.
Do not mix them with patient revenue issues. The sources and owners are different.
HFMA says RCM covers patient service revenue. Payer work stays in that column.
Lease costs come from signed terms and landlord bills. They need another proof path.
Start with two lanes
Build the bridge from firm records. Use one period across all rows.
| Lane | What it tests | Main source | Owner |
|---|---|---|---|
| Patient revenue | Claims and payment gaps | RCM records | RCM lead |
| Lease costs | Landlord charges and lease terms | Lease and CAM files | Lease cost lead |
Do not move a payer estimate into lease costs. Do not move rent into claims work.
The bridge joins the final view. It does not join the source tests.
Split every lease cost
Base rent is only one line. Show each other cost on its own row.
Use these row types:
- Base rent
- CAM
- Property taxes
- Insurance
- Utilities
- Lease cost review item
CAM means common area maintenance. It covers shared property costs under lease terms.
AAFP tells practices to review lease terms. Its guide also names common area and insurance costs.
The guide is from May 2010. Use it for structure, not current cost levels.
SQ/FT explains that CAM sits outside base rent. It also describes a later true-up.
That page is a broker guide. Do not copy its market figures as facts.
Add an evidence state
Each row needs a source state. A change alone is not enough.
Use four states:
| State | Meaning | What to show |
|---|---|---|
| Booked | The income statement holds the cost | Account and period |
| Billed | A landlord bill supports the cost | File and line |
| Checked | The lease and bill were compared | Clause and math |
| Open | A source or answer is missing | Gap and owner |
Do not label an open row as a review item. Keep it as a question.
Use review item only after the firm checks the sources.
A checked row may show no issue. Record that result with its sources.
Build the bridge fields
Use one row for each cost and period.
| Field | What to enter |
|---|---|
| Review lane | Patient revenue or lease cost |
| Cost type | Rent, CAM, tax, insurance, or utility |
| Source period | The dates covered |
| Source file | File name and page |
| Amount type | Booked, billed, or checked |
| Current amount | The source amount |
| Prior amount | A matched past amount |
| Change reason | Known cause or open question |
| Evidence state | Booked, billed, checked, or open |
| Decision owner | One named reviewer |
Stop when periods do not match. A calendar year cannot hide a partial period.
Also stop for unclear lease meaning. Send that clause to counsel.
Walk a sample bridge
This example is fictional. The firm name and amounts are made up.
Meadow Health uses a 2025 review period. Every row uses that same year.
| Lane | Cost type | Amount | State | Source note |
|---|---|---|---|---|
| Patient revenue | Payer issue | $12,000 | Open | Firm estimate |
| Lease cost | Base rent | $96,000 | Booked | Income statement |
| Lease cost | CAM | $24,000 | Billed | CAM statement |
| Lease cost | Taxes | $7,500 | Billed | CAM statement |
| Lease cost | Insurance | $3,200 | Open | Support missing |
| Lease cost | Utilities | $6,400 | Booked | Utility account |
| Lease cost | CAM review item | $1,600 | Checked | Clause and math |
The $12,000 payer row stays outside landlord work. It needs RCM proof.
The insurance row lacks support. No one calls it wrong.
The $1,600 CAM row has source math. It is a review item, not a result promise.
The bridge shows three different decisions. It does not add them into one claim.
Show checked math
A checked lease row needs repeatable math. Show every input and source.
| Input | Value | Source |
|---|---|---|
| Prior accepted base | $10,000 | Prior statement |
| Lease cap | 4% | Signed lease |
| Current billed amount | $12,000 | Current statement |
| Modeled cap amount | $10,400 | $10,000 times 1.04 |
| Review difference | $1,600 | $12,000 less $10,400 |
These figures are fictional. They show the method only.
The lease still controls cap scope. Route unclear scope to counsel.
Occupier lists rent exposure and total site costs. It also names CAM true-ups and money landlords pay back.
Those fields can shape the bridge. They do not prove a client outcome.
Set the service scope with the medical lease advice guide.
Rank client rows with the medical CAM queue.
Move approved margin rows into the MSO cost dashboard.
Tie this bridge to client work in the RCM pillar.
Compare service paths in the growth hub.
Find more margin guides in the expense hub.
Where CAMAudit fits
An RCM consultant owns the two-lane margin bridge. CAMAudit supports landlord charge rows.
CAMAudit reads supplied lease and CAM files. It can flag source-linked review items.
Your firm reviews and signs the branded CAM audit. You then update the bridge.
A checked margin item may support a dispute letter draft. Your firm reviews it.
It is not legal advice. Have counsel review before sending.
Use the service line guide to define client scope.