Where you are
Review workflow
Six steps from assumptions to export. Your current step is highlighted — click any step to jump straight to it.
Review Dashboard
Advance cases from modeled possibility to evidence, approval, submission, and payment.
Revenue qualification waterfall
Modeled opportunity is kept separate from actual recovered revenue.
Next actions
Trust and data coverage
Medical direction review
Normally launched from an applicable case so the review remains linked.
Quick Case Count Estimate
Use this when the CFO only has monthly anesthesia case counts by hospital, campus, or system.
Monthly anesthesia case counts by hospital, campus, or period.
Gap minutes per case → annual gap hours → CRNA capacity and realizable value.
Decide whether the opportunity is large enough to justify case-level analysis.
Enter case counts, choose the procedure category, and review a directional opportunity estimate.
annual gap hours = cases × gap minutes ÷ 60 × annualization multiplier annual capacity value = annual gap hours × fully loaded CRNA hourly cost potential realizable value = annual capacity value × realization %
Results
Directional estimate — confirm with case-level data before acting.Case Count Rows
| Hospital / Location | Period | Cases | Procedure Category | Gap min/case | Realization % | Annual gap hours | Annual capacity value | Potential realizable value |
|---|
Show conservative / expected / aggressive view
Case-Count Range
Uses total case count across all rows and applies three assumptions to show a CFO-friendly range.
| Scenario | Total Cases | Gap min/case | Realization | Annual gap hours | Hourly cost | Annual capacity value | Potential realizable value |
|---|
OR Profile Estimate
Estimate potential opportunity from OR capacity and utilization before case-level data is available.
OR count, hours/day, days/week, utilization, and average case length.
Estimated weekly cases × handoff gap → annual CRNA capacity and realizable value.
Size opportunity from capacity assumptions when no case data exists yet.
Results
Scenario estimate from capacity assumptions — not case-verified.OR Group Builder
| Group | # ORs | Hours/day | Days/week | Avg case min |
|---|
Conservative / Expected / Aggressive View
| Scenario | Handoff min | Realization | Annual gap hours | Annual capacity value | Potential realizable value |
|---|
Case-Level Analyzer
Upload OR/anesthesia case data and generate an auditable time-capture review worklist.
De-identified case data (CSV/TSV) with anesthesia end and a PACU / endpoint timestamp.
Per case: documented vs supported minutes → delta units, dollars, severity, confidence.
Build a prioritized, auditable review worklist with a full evidence trace.
Upload de-identified case data, confirm mappings, and review only the cases most likely to need follow-up.
PHI preflight checklist
PHI Preflight Checklist
- Remove patient name, MRN, DOB, account number, address, phone, email, and SSN.
- Use case IDs or internal review IDs instead of direct patient identifiers.
- Confirm the file is appropriate for this local browser workflow before upload.
- If PHI is required later, use an approved HIPAA deployment and vendor agreement.
- Service dates, free text, and unique case codes may remain identifying; this application does not perform or certify HIPAA de-identification.
Status: approved de-identification process not yet confirmed.
Off by default: only composite-keyed review metadata, linked checklists, local activity history, and settings persist. Turn this on to also restore uploaded case rows after a refresh; only do so when the device and browser storage are approved for the data.
Medical Direction 7-Step Verification
Guidance and PHI reminder
Avoid patient names, MRNs, diagnoses, account numbers, or other PHI. Launch from a case when possible, verify each item against its own record evidence, then generate the report. Evidence references may be reused only when the same source genuinely supports multiple requirements.
Case-linked review
Standalone reviewOptional report details
Seven Medical Direction Steps
Additional Guardrails
Create Shareable Report
Generate a full report with assumptions, calculations, estimator results, quick case-count estimates, and case-level analyzer results if data has been uploaded.
Generate a concise report, then export only the format you need.
Completed Quick or OR Profile estimates, and/or analyzer results.
Assumptions, calculations, estimates, and worklist into one shareable document.
Share a defensible, compliance-aware summary with finance and leadership.
Sensitivity Analysis
Shows how modeled expected value changes when handoff minutes, scenario realization, and conversion factor assumptions move.
Report Preview
Settings
Billing Profile Editor
Create or update payer/review profiles without editing config/config.json.
Configuration
Factory defaults load from config/config.json. Exported/imported settings are user state and can be shared across hospital profiles or analysis sessions.
Help
Run a compliance-first anesthesia time-capture review without leaving the app.
Recommended Review Workflow
- Set shared assumptions. For the default operational view, select the reporting period, procedure category, handoff minutes, fully loaded CRNA hourly cost, and realization percentage. For advanced billing review, also verify the payer profile, time-unit convention, rounding, conversion factor, recoverability, and timely filing window.
- Size the opportunity. Use Quick Estimate for a CFO-friendly case-count view or OR Profile Estimate when room utilization and average case length are known.
- Prepare case data. Export de-identified OR/anesthesia case data to CSV or TSV.
- Upload and map columns. Confirm the recorded anesthesia end field and at least one supported endpoint field.
- Run analysis. Review data-quality warnings, mapping gaps, possible PHI headers, excluded rows, and the case worklist.
- Review case evidence. Inspect endpoint source, formula trace, warnings, issues, and the review checklist.
- Assign review status. Track documentation requests, provider attestation, billing review approval, rejection, submission, recovery, denial, or closure.
- Use 7-Step Direction when needed. For medically directed cases, verify the seven medical direction documentation elements and concurrency guardrails, then generate a short supplemental report.
- Export the right packet. Export the worklist, provider list, attestation packet, compliance packet, audit trail, sensitivity view, full report, 7-step direction report, or analysis JSON.
Operational Capacity Calculation
This is the recommended executive calculation because it uses familiar measures—cases, minutes, hours, and labor cost. It does not depend on anesthesia billing units or payer rules.
period gap minutes = cases × average gap minutes per case annual gap hours = period gap minutes ÷ 60 × annualization multiplier annual CRNA capacity value = annual gap hours × fully loaded CRNA hourly cost potential realizable value = annual CRNA capacity value × realization %
Worked example: monthly case count
Assume 1,000 cases per month, a 10-minute average gap, a $110 fully loaded CRNA hourly cost, and 30% realization.
- 1,000 cases × 10 minutes = 10,000 gap minutes per month.
- 10,000 ÷ 60 = 166.7 gap hours per month.
- 166.7 × 12 = 2,000 annual gap hours.
- 2,000 × $110 = $220,000 annual CRNA capacity value.
- $220,000 × 30% = $66,000 potential realizable value.
Interpretation: $220,000 is the cost value of the time represented by the modeled gap. It is not automatically a budget reduction. The $66,000 realization estimate is a planning scenario that should be tied to a measurable result such as lower overtime, avoided agency labor, increased staffed capacity, or additional cases.
Annualization multipliers
| Entered case count represents | Multiplier | Example |
|---|---|---|
| Monthly total | ×12 | 1,000 monthly cases become 12,000 annual cases |
| Quarterly total | ×4 | 3,000 quarterly cases become 12,000 annual cases |
| Annual total | ×1 | 12,000 annual cases remain 12,000 |
OR Profile Calculation
Use this when case counts are unavailable but OR capacity is known.
scheduled OR hours/week = ORs × hours/day × days/week estimated cases/week = scheduled OR hours/week × utilization % × 60 ÷ average case minutes annual gap hours = estimated cases/week × gap minutes ÷ 60 × 52 annual CRNA capacity value = annual gap hours × CRNA hourly cost
Example: Six ORs operating eight hours per day, five days per week, at 75% utilization with a 70-minute average case produce about 154 cases per week. At five gap minutes per case, that is about 669 annual gap hours, worth approximately $66,900 in annual CRNA capacity at $100 per hour. At 30% realization, the planning value is about $20,100.
Advanced Billing-Revenue Calculation
This optional view is for revenue-cycle and compliance review. It converts modeled incremental minutes into anesthesia time units. The configured unit duration, rounding method, payer conversion factor, documentation requirements, and timely filing rules must be verified before the result is used externally.
total gap minutes = cases × average gap minutes delta time units = total gap minutes ÷ configured billing-unit minutes modeled gross billing opportunity = delta units × conversion factor modeled recoverable value = gross opportunity × recoverability %
Worked example
For 1,000 monthly cases and a 10-minute gap, the model produces 10,000 incremental minutes. At 15 minutes per time unit, that is about 666.7 units. At $80 per unit, modeled gross opportunity is about $53,333 for the entered month; at 60% recoverability, modeled recoverable value is about $32,000.
Important: The quick estimate aggregates minutes for directional planning. Claim-level rounding and payer rules can produce different results. Use the case-level analyzer, verified payer terms, documentation review, provider attestation where appropriate, and compliance approval before claim action.
Mode Guide
Quick Estimate
Use this when you only know case counts by hospital, campus, or period. By default it converts handoff minutes to annual CRNA hours and capacity value. An advanced billing-revenue view is available when payer-specific analysis is appropriate.
OR Profile Estimate
Use this before case-level data is available. Enter room count, hours, days, utilization, average case length, and handoff assumptions.
Case-Level Analyzer
Use this when you have CSV or TSV case data. For evaluation, choose Load Demo Data. For a real upload, download the CSV template and data dictionary first.
Create Report
Produce a shareable summary with assumptions, calculations, estimates, analyzer results, and compliance reminders.
7-Step Direction
Launch this from a case whenever possible. Verify each element against the record, cite the supporting location, confirm concurrency and availability guardrails, then generate a linked report.
Settings
Inspect configuration, edit billing profiles, and export/import reusable settings.
Preparing Upload Data
Each row should represent one anesthesia case. De-identify data before upload whenever possible.
Recommended fields
- Case ID, date of service, site, OR room, and procedure type.
- Anesthesia start and recorded anesthesia end.
- Patient out room, PACU arrival, or PACU handoff accepted.
- Procedure category, provider, role, modifier, payer, claim status, and documentation status.
Avoid direct identifiers
- Patient name, MRN, date of birth, account number, address, phone, email, or SSN.
Supported Endpoint Hierarchy
For each case, the analyzer chooses the strongest available endpoint in this order:
- PACU handoff accepted time: strongest evidence of completed transfer of care.
- PACU arrival time: useful when accepted-handoff time is unavailable.
- Patient out room plus procedure-category handoff minutes: directional estimate for prioritization when stronger endpoints are unavailable.
If the supported endpoint appears before recorded anesthesia end, delta minutes are set to zero and the app adds a warning.
Procedure, Payer, and Provider Pattern Logic
- Procedure categories: General Surgery, Ortho, Cardio, GI, OB-GYN, Urology, Neurosurgery, Ophthalmology, ENT, Plastics, Vascular, Radiology, Oncology, Trauma, Transplant, Podiatry, Pediatric, and Bedside each have their own default PACU-to-anesthesia-end assumption.
- Primary payer profiles: payer templates are editable but remain unverified until facility, jurisdiction, source, effective date, approver, and approval date are recorded. Unverified values stay outside the qualified-revenue waterfall.
- Provider timing watchlist: flags providers with repeated round-number anesthesia end times, exact PACU offsets, or less-than-threshold PACU gaps for compliance and revenue-cycle review.
7-Step Direction Checklist
Use the 7-Step Direction tab when a case is being reviewed for Medicare-style medical direction rather than personally performed anesthesia or medical supervision. The page is intentionally lightweight so a reviewer can finish the check without creating a second full chart.
- Enter an internal case reference, reviewer, and the maximum number of concurrent anesthesia services.
- Check the seven required medical direction elements when the anesthesia record supports them.
- Enter an evidence location for every checked item. Use Reuse Record Reference in Blank Fields only when the same source genuinely supports multiple requirements.
- Confirm the two guardrails: no more than four concurrent services and immediate availability not compromised by other services.
- Generate, copy, or print the supplemental report for the review packet.
The checklist is a documentation aid. The anesthesia record, payer policy, coding guidance, and compliance review remain the source of truth.
Interpreting Results
- Annual gap hours: entered cases multiplied by average gap minutes, divided by 60, and annualized according to the selected period.
- Annual CRNA capacity value: annual gap hours multiplied by the fully loaded CRNA hourly cost. This is the value of capacity represented by the gap, not automatic cash savings.
- Potential realizable value: annual CRNA capacity value multiplied by the planning realization percentage. Validate the benefit through reduced overtime, avoided contract labor, added case capacity, or another measurable outcome.
- Procedure category: mapped or inferred category used for category-specific handoff assumptions.
- Payer profile: payer-specific conversion factor used for case-level opportunity calculations.
- Documented minutes: anesthesia start to recorded anesthesia end, or reported billed minutes if start is unavailable.
- Supported minutes: anesthesia start to selected supported endpoint.
- Delta minutes: supported minutes minus documented minutes, never below zero.
- Delta units: an advanced billing-review measure that converts supported incremental minutes to anesthesia time units using the configured payer method.
- Modeled gross opportunity: delta units multiplied by the configured conversion factor.
- Modeled expected value: modeled gross multiplied by a planning realization assumption. It is not submitted or paid revenue.
- Revenue waterfall: separates potential, evidence-supported, documentation-qualified, approved, submitted, and actually paid amounts.
- Timing flags: compliance/revenue review signals for rounded end times, exact PACU offsets, and small PACU gaps.
- Confidence: score based on endpoint strength, warnings, documentation, timely filing, and completeness.
Exports
- Quick Estimate CSV/Text/Markdown/PDF.
- Billing Review Worklist CSV.
- Provider Worklist CSV.
- Provider Attestation Packet.
- Compliance Packet Markdown.
- Audit Trail CSV.
- Sensitivity CSV.
- 7-Step Direction supplemental report.
- Full Report and Analysis JSON.
Troubleshooting
No cases are flagged
Check that recorded anesthesia end and at least one endpoint are mapped correctly. For operational estimates, review case counts, period, handoff minutes, CRNA hourly cost, and realization. For billing review, also review unit, rounding, payer, and recoverability assumptions.
Timestamps look wrong
Use a consistent date/time format. If the date is separate from the time, map the date column. Overnight sequences are supported, but inconsistent source data can still create warnings.
Opportunity looks overstated
For operational estimates, lower the realization assumption, validate hourly cost, and use conservative measured handoff time. For billing review, lower recoverability, verify the payer profile, require stronger endpoint evidence, and filter to high-confidence rows before presenting estimates.
Possible PHI warning appears
Review detected column names before analysis or sharing. Remove direct identifiers unless the workflow and deployment are approved for PHI.
7-Step Direction says medical direction is not supported
Check the concurrency value first. More than four concurrent anesthesia services generally moves the review away from medical direction and toward medical supervision logic. Also confirm that every required element is checked and that evidence locations are present.
Compliance Guardrail
This tool identifies potential billing-review opportunities and helps assemble supplemental medical direction documentation checks. It does not determine billing eligibility. Documentation review, payer rules, provider attestation, timely filing requirements, coding guidance, and compliance approval are required before claim correction or rebilling.
About HandoffGap
A compliance-first workbench for finding anesthesia time that may deserve human review.
Purpose
Many anesthesia billing and documentation workflows focus on recorded anesthesia start and stop times. In real operations, providers and CRNAs may continue patient care during transfer and handoff after the time captured as anesthesia end. HandoffGap makes that possible omitted time visible for structured review.
The application compares documented anesthesia time with supported endpoints such as PACU handoff accepted time, PACU arrival, or patient-out-room plus a configured handoff assumption. It also includes a 7-Step Direction mode for lightweight medical direction documentation review.
Two Different Questions, Two Separate Value Views
| View | Question answered | Primary inputs | Best audience |
|---|---|---|---|
| Operational CRNA capacity (default) | How much clinician time and labor capacity may be represented by the handoff gap? | Cases, gap minutes, reporting period, CRNA hourly cost, realization | Operations, finance, anesthesia leadership |
| Advanced billing revenue | How much incremental billing value may warrant compliant case-level review? | Minutes, time-unit rule, rounding, payer conversion factor, recoverability | Revenue cycle, coding, compliance |
The views should not be added together. They are alternative ways to evaluate the same modeled handoff-time gap for different business questions.
How To Read The Operational Result
For 1,000 monthly cases with a 10-minute average gap, HandoffGap calculates 2,000 annual gap hours. At a fully loaded CRNA cost of $110 per hour, the annual capacity value is $220,000. With a 30% realization assumption, potential realizable value is $66,000.
- 2,000 hours is the modeled capacity represented by the gap.
- $220,000 values those hours at the entered labor cost; it is not guaranteed savings.
- $66,000 is a planning scenario that assumes 30% of the capacity can create a measurable benefit.
Who It Is For
- Anesthesia group leaders evaluating handoff-time documentation.
- Revenue-cycle analysts estimating possible time-capture opportunity.
- Compliance teams reviewing assumptions, evidence, medical direction documentation, and guardrails.
- Perioperative operations leaders comparing sites, providers, procedures, and payer groups.
- Finance stakeholders who need a conservative directional opportunity view.
What It Does Not Do
- It does not determine whether a claim is billable or rebillable.
- It does not replace payer-specific rules, medical-record review, provider attestation, or compliance approval.
- It does not prove medical direction by itself; the anesthesia record must support the seven required elements.
- It does not guarantee recoverable revenue.
- It should not be used with PHI unless the deployment and workflow are approved for that use.
What The App Does
- Provides a guided workflow from assumptions through export.
- Loads de-identified demo data and exports a CSV template plus data dictionary.
- Creates quick CFO-friendly annual CRNA capacity estimates from case counts, gap minutes, and hourly cost.
- Models OR profile opportunity from room count, utilization, case length, and handoff assumptions.
- Analyzes uploaded CSV or TSV case data in the browser.
- Lets users edit payer/billing profiles without changing JSON files.
- Offers a separate advanced billing view that calculates delta minutes, delta units, gross opportunity, and estimated recoverable opportunity.
- Scores confidence and severity based on endpoint quality, documentation status, timely filing, warnings, and assumptions.
- Maintains a case-level audit trail for status, reviewer, and note changes.
- Provides a fast 7-Step Direction checklist for medical direction documentation review, including concurrency and immediate-availability guardrails.
- Produces worklists, provider documentation lists, attestation packets, compliance packets, reports, sensitivity analysis, and resumable analysis JSON.
Source Of Truth Records
- Shared billing and review assumptions.
- Uploaded case rows and column mappings.
- Supported endpoint evidence and calculation traces.
- Medical direction checklist answers, evidence locations, concurrency, and generated supplemental reports.
- Case-level review status, notes, warnings, and issues.
- Provider, site, procedure, and payer rollups.
- Exported worklists, compliance packet, and analysis session JSON.
Privacy And Deployment
This version is a static client-side web app. It runs locally in the browser and loads defaults from config/config.json. Uploaded data is not intentionally sent to a server by the app.
If the app is later hosted or expanded for multi-user use, add authentication, access controls, encryption, audit logs, secure storage, HIPAA-appropriate hosting, and approved vendor agreements.
Why This Matters
The business question is not simply whether more time can be billed. Leaders first need to understand whether the gap represents meaningful clinical capacity and whether any portion can be converted into an observable operational result. If billing review is pursued, the organization must then trace the evidence, review documentation and medical direction where relevant, apply payer rules, obtain provider confirmation where appropriate, and make compliant decisions without scattered spreadsheets and memory.
Methodology Limits
- Case-count and OR-profile estimates are hypotheses until validated against facility data.
- Capacity value is not the same as cash savings, revenue, or budget reduction.
- Realization depends on management action and should be measured through an agreed operational outcome.
- Procedure-category handoff assumptions should be replaced with observed site-level transfer times when sufficient data exists.
- Billing estimates do not determine eligibility and may differ from claim-level results because of rounding, payer, documentation, modifier, medical direction, and timely filing rules.
- The two value views are alternatives and should not be combined into one total.