{
  "schemaVersion": "1.0",
  "item": {
    "slug": "afrexai-medical-billing",
    "name": "Medical Billing & Revenue Cycle",
    "source": "tencent",
    "type": "skill",
    "category": "数据分析",
    "sourceUrl": "https://clawhub.ai/1kalin/afrexai-medical-billing",
    "canonicalUrl": "https://clawhub.ai/1kalin/afrexai-medical-billing",
    "targetPlatform": "OpenClaw"
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  "install": {
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    "sourceDownloadUrl": "https://wry-manatee-359.convex.site/api/v1/download?slug=afrexai-medical-billing",
    "sourcePlatform": "tencent",
    "targetPlatform": "OpenClaw",
    "installMethod": "Manual import",
    "extraction": "Extract archive",
    "prerequisites": [
      "OpenClaw"
    ],
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      "README.md",
      "SKILL.md"
    ],
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      "Download the package from Yavira.",
      "Extract the archive and review SKILL.md first.",
      "Import or place the package into your OpenClaw setup."
    ],
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      "summary": "Hand the extracted package to your coding agent with a concrete install brief instead of figuring it out manually.",
      "steps": [
        "Download the package from Yavira.",
        "Extract it into a folder your agent can access.",
        "Paste one of the prompts below and point your agent at the extracted folder."
      ],
      "prompts": [
        {
          "label": "New install",
          "body": "I downloaded a skill package from Yavira. Read SKILL.md from the extracted folder and install it by following the included instructions. Then review README.md for any prerequisites, environment setup, or post-install checks. Tell me what you changed and call out any manual steps you could not complete."
        },
        {
          "label": "Upgrade existing",
          "body": "I downloaded an updated skill package from Yavira. Read SKILL.md from the extracted folder, compare it with my current installation, and upgrade it while preserving any custom configuration unless the package docs explicitly say otherwise. Then review README.md for any prerequisites, environment setup, or post-install checks. Summarize what changed and any follow-up checks I should run."
        }
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      "expiresAt": "2026-04-30T16:43:11.935Z",
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        "redirectLocation": null,
        "bodySnippet": null
      },
      "scope": "source",
      "summary": "Source download looks usable.",
      "detail": "Yavira can redirect you to the upstream package for this source.",
      "primaryActionLabel": "Download for OpenClaw",
      "primaryActionHref": "/downloads/afrexai-medical-billing"
    },
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        "Use the Yavira download entry.",
        "Review SKILL.md after the package is downloaded.",
        "Confirm the extracted package contains the expected setup assets."
      ],
      "postInstallChecks": [
        "Confirm the extracted package includes the expected docs or setup files.",
        "Validate the skill or prompts are available in your target agent workspace.",
        "Capture any manual follow-up steps the agent could not complete."
      ]
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    "agentPageUrl": "https://openagent3.xyz/skills/afrexai-medical-billing/agent",
    "manifestUrl": "https://openagent3.xyz/skills/afrexai-medical-billing/agent.json",
    "briefUrl": "https://openagent3.xyz/skills/afrexai-medical-billing/agent.md"
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  "agentAssist": {
    "summary": "Hand the extracted package to your coding agent with a concrete install brief instead of figuring it out manually.",
    "steps": [
      "Download the package from Yavira.",
      "Extract it into a folder your agent can access.",
      "Paste one of the prompts below and point your agent at the extracted folder."
    ],
    "prompts": [
      {
        "label": "New install",
        "body": "I downloaded a skill package from Yavira. Read SKILL.md from the extracted folder and install it by following the included instructions. Then review README.md for any prerequisites, environment setup, or post-install checks. Tell me what you changed and call out any manual steps you could not complete."
      },
      {
        "label": "Upgrade existing",
        "body": "I downloaded an updated skill package from Yavira. Read SKILL.md from the extracted folder, compare it with my current installation, and upgrade it while preserving any custom configuration unless the package docs explicitly say otherwise. Then review README.md for any prerequisites, environment setup, or post-install checks. Summarize what changed and any follow-up checks I should run."
      }
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  "documentation": {
    "source": "clawhub",
    "primaryDoc": "SKILL.md",
    "sections": [
      {
        "title": "Medical Billing & Revenue Cycle Management",
        "body": "Analyze medical billing workflows, identify revenue leaks, optimize claim submissions, and reduce denial rates. Built for healthcare practices, billing companies, and revenue cycle teams."
      },
      {
        "title": "CPT/ICD-10 Coding Accuracy",
        "body": "Common coding errors by specialty (top 10 per specialty)\nModifier usage: 25, 59, 76, 77, AI, AS — when required vs when it triggers audit\nE/M level selection (2021 guidelines): time-based vs MDM-based\nEvaluation matrix: does documentation support the code billed?"
      },
      {
        "title": "Claim Denial Analysis",
        "body": "Denial reason code lookup (CARC/RARC codes)\nTop 20 denial reasons across commercial + Medicare + Medicaid\nRoot cause mapping: front-desk error, coding error, clinical documentation, payer policy\nAppeal letter framework by denial type (with timelines)\nClean claim rate benchmark: 95%+ target"
      },
      {
        "title": "Revenue Cycle KPIs",
        "body": "MetricTargetRed FlagDays in A/R<35>50Clean claim rate>95%<90%First-pass resolution>90%<80%Denial rate<5%>10%Collection rate>95%<90%Cost to collect<4%>7%Net collection rate>96%<92%"
      },
      {
        "title": "Payer Contract Analysis",
        "body": "Fee schedule comparison: Medicare vs commercial rates by CPT\nAllowed amount benchmarking (what you should be getting paid)\nUnderpayment detection: compare ERA/835 to contracted rates\nRate negotiation prep: volume data, market rates, quality metrics"
      },
      {
        "title": "Compliance & Audit Readiness",
        "body": "OIG Work Plan items relevant to your specialty\nStark Law / Anti-Kickback safe harbors checklist\nFalse Claims Act risk factors\nInternal audit sampling methodology (statistically valid)\nDocumentation improvement programs (CDI)"
      },
      {
        "title": "Charge Capture Optimization",
        "body": "Missed charge identification by department\nCharge lag analysis (days from service to charge entry)\nSuperbill/encounter form design best practices\nCommon missed revenue: vaccines, injections, supplies, time-based codes"
      },
      {
        "title": "Patient Financial Responsibility",
        "body": "Eligibility verification workflow (real-time vs batch)\nPrior authorization tracking and requirements by payer\nPatient estimate generation (good faith estimate compliance)\nCollections strategy: statements → calls → agency threshold\nNo Surprises Act compliance checklist"
      },
      {
        "title": "Usage",
        "body": "Give the agent your:\n\nSpecialty (orthopedics, cardiology, primary care, etc.)\nPayer mix (% Medicare, Medicaid, commercial, self-pay)\nCurrent KPIs (denial rate, days in A/R, collection rate)\nProblem area (denials, underpayments, coding, compliance)\n\nThe agent will analyze against benchmarks and give specific, actionable recommendations."
      },
      {
        "title": "Example Prompts",
        "body": "\"Our orthopedic practice has a 12% denial rate. Top reasons are CO-4 and CO-16. Analyze root causes.\"\n\"Compare our cardiology fee schedule to Medicare rates for our top 20 CPTs.\"\n\"Build an appeal letter for a CO-197 denial on CPT 99214 with modifier 25.\"\n\"Audit our E/M coding distribution — we're billing 80% level 3. Is that normal for family medicine?\"\n\"Our days in A/R jumped from 32 to 48 in two months. What should we investigate?\""
      },
      {
        "title": "Industry Context",
        "body": "Medical billing errors cost US healthcare $935 million per week. The average practice loses 5-10% of revenue to preventable billing issues. Denial management alone can recover 2-5% of net revenue when done right.\n\nBuilt by AfrexAI — AI agent context packs for regulated industries. Get the full Healthcare AI Context Pack with 50+ frameworks at our storefront."
      }
    ],
    "body": "Medical Billing & Revenue Cycle Management\n\nAnalyze medical billing workflows, identify revenue leaks, optimize claim submissions, and reduce denial rates. Built for healthcare practices, billing companies, and revenue cycle teams.\n\nWhat This Covers\nCPT/ICD-10 Coding Accuracy\nCommon coding errors by specialty (top 10 per specialty)\nModifier usage: 25, 59, 76, 77, AI, AS — when required vs when it triggers audit\nE/M level selection (2021 guidelines): time-based vs MDM-based\nEvaluation matrix: does documentation support the code billed?\nClaim Denial Analysis\nDenial reason code lookup (CARC/RARC codes)\nTop 20 denial reasons across commercial + Medicare + Medicaid\nRoot cause mapping: front-desk error, coding error, clinical documentation, payer policy\nAppeal letter framework by denial type (with timelines)\nClean claim rate benchmark: 95%+ target\nRevenue Cycle KPIs\nMetric\tTarget\tRed Flag\nDays in A/R\t<35\t>50\nClean claim rate\t>95%\t<90%\nFirst-pass resolution\t>90%\t<80%\nDenial rate\t<5%\t>10%\nCollection rate\t>95%\t<90%\nCost to collect\t<4%\t>7%\nNet collection rate\t>96%\t<92%\nPayer Contract Analysis\nFee schedule comparison: Medicare vs commercial rates by CPT\nAllowed amount benchmarking (what you should be getting paid)\nUnderpayment detection: compare ERA/835 to contracted rates\nRate negotiation prep: volume data, market rates, quality metrics\nCompliance & Audit Readiness\nOIG Work Plan items relevant to your specialty\nStark Law / Anti-Kickback safe harbors checklist\nFalse Claims Act risk factors\nInternal audit sampling methodology (statistically valid)\nDocumentation improvement programs (CDI)\nCharge Capture Optimization\nMissed charge identification by department\nCharge lag analysis (days from service to charge entry)\nSuperbill/encounter form design best practices\nCommon missed revenue: vaccines, injections, supplies, time-based codes\nPatient Financial Responsibility\nEligibility verification workflow (real-time vs batch)\nPrior authorization tracking and requirements by payer\nPatient estimate generation (good faith estimate compliance)\nCollections strategy: statements → calls → agency threshold\nNo Surprises Act compliance checklist\nUsage\n\nGive the agent your:\n\nSpecialty (orthopedics, cardiology, primary care, etc.)\nPayer mix (% Medicare, Medicaid, commercial, self-pay)\nCurrent KPIs (denial rate, days in A/R, collection rate)\nProblem area (denials, underpayments, coding, compliance)\n\nThe agent will analyze against benchmarks and give specific, actionable recommendations.\n\nExample Prompts\n\"Our orthopedic practice has a 12% denial rate. Top reasons are CO-4 and CO-16. Analyze root causes.\"\n\"Compare our cardiology fee schedule to Medicare rates for our top 20 CPTs.\"\n\"Build an appeal letter for a CO-197 denial on CPT 99214 with modifier 25.\"\n\"Audit our E/M coding distribution — we're billing 80% level 3. Is that normal for family medicine?\"\n\"Our days in A/R jumped from 32 to 48 in two months. What should we investigate?\"\nIndustry Context\n\nMedical billing errors cost US healthcare $935 million per week. The average practice loses 5-10% of revenue to preventable billing issues. Denial management alone can recover 2-5% of net revenue when done right.\n\nBuilt by AfrexAI — AI agent context packs for regulated industries. Get the full Healthcare AI Context Pack with 50+ frameworks at our storefront."
  },
  "trust": {
    "sourceLabel": "tencent",
    "provenanceUrl": "https://clawhub.ai/1kalin/afrexai-medical-billing",
    "publisherUrl": "https://clawhub.ai/1kalin/afrexai-medical-billing",
    "owner": "1kalin",
    "version": "1.0.0",
    "license": null,
    "verificationStatus": "Indexed source record"
  },
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}