# Signal — Master Summary
### Strategic Analysis Package | STTIL Solutions LLC | April 2026

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## What This Package Contains

| File | Description |
|------|-------------|
| Analysis/signal-cgm-segment-scoring-v1.md | Three-model scoring: SaaS ICP, Asset Sale, Pilot Validation across 7 segments |
| Analysis/signal-cgm-re-scored-composite-v2.md | Composite re-score (50/30/20 weights) with MA + Medicaid payer scope applied |
| Analysis/signal-cgm-final-ranking-leverage-v3.md | Final four-segment ranking, denial quantification, six leverage points |
| Assets/signal-cgm-pitch-v1-plain.md | Leave-behind: plain language / social media (6th grade reading level) |
| Assets/signal-cgm-pitch-v2-professional.md | Leave-behind: professional (mid-size and larger billing organizations) |

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## Final Composite Rankings (MA + Medicaid Scope · Asset Sale Primary)

| Rank | Segment | Composite Score | Primary Use |
|------|---------|----------------|-------------|
| #1 | Billing company / DME RCM outsourcer | **7.61** | Pilot partner + asset buyer |
| #2 | NikoHealth-type platform vendor | **7.34** | Primary asset sale target |
| #3 | VGM Group / MSO | **5.72** | Follow-on distribution post-sale |
| #4 | Mid-size independent supplier | **5.36** | SaaS ICP if pivot away from asset sale |

**Weights:** Asset sale 50% · Pilot 30% · SaaS 20%

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## Key Metrics (All Sources: CMS 2024 / OIG 2025 / KFF 2024)

| Metric | Value |
|--------|-------|
| CGM improper payment rate (Medicare) | 25.2% |
| Projected annual CGM improper payments | $278.5M |
| Share from documentation failures (CERT 2019) | 68.6% of errors |
| Net revenue loss after appeals (per supplier) | ~20% of gross CGM billing |
| Permanently written off (not recovered) | ~63% of denied claim value |
| Recovered through L1+L2 appeals | ~28% of denied claim value |
| MA DMEPOS appeal success rate (L2) | 63.9% |
| MA prior auth denial rate | 7.7% of PA requests |
| Traditional HME supplier locations (2024) | ~8,005 (−38% from 2013) |

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## Leverage Priority Stack (Workflow Intervention Points)

1. **Prior Authorization** (9.2/10) — Only denial type with zero recovery path
2. **Refill Tracking / Coverage Clock** (8.8/10) — Enabling infrastructure for everything
3. **6-Month Visit Compliance** (8.1/10) — Highest-frequency daily queue driver
4. **PECOS Validation at Each Refill** (7.4/10) — Hard write-off prevention
5. **Intake Validation** (6.5/10) — Front-door pipeline defense
6. **Audit Defense Log** (5.8/10) — Compliance record as system byproduct

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## Sequencing Recommendation

```
Week 1–2:   Identify 2–3 billing company targets with CGM-active client books
Week 2–4:   Approach with Version 1 or 2 leave-behind; propose 60-day pilot
Week 4–8:   Execute pilot on live MA + Medicaid CGM data under BAA
Week 8:     Deliver denial risk exposure report (before/after)
Week 9–12:  Use pilot evidence to open NikoHealth asset sale conversation
            at higher valuation than current $45K–$65K ask
Week 12+:   Parallel VGM vendor partner program conversation for distribution
```

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## Validated Hypotheses Status (as of April 2026)

| Hypothesis | Status | Method |
|-----------|--------|--------|
| H1: Denials are documentation-fixable | **Confirmed by CERT 2019** — 32.8% error rate; 68.6% from documentation | Desk research (CMS CERT 2019) |
| H2: April 13 PA expansion is live and unpatched | **Likely confirmed** — no incumbent updated | Requires 2–3 discovery calls to verify |
| H3: CB 2028 deadline drives active buying urgency | **Untested** | Requires 5 discovery calls with owner-operators |

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## Next-Steps Prompt for Next Claude Code Session

> Continue Signal go-to-market execution. All strategic analysis is
> in CGM-Denial-Prevention/01-Claude-Outputs/. The asset sale target ranking
> is: #1 Billing company (pilot first), #2 NikoHealth (asset sale after pilot
> evidence). Payer scope: Medicare Advantage and Medicaid as first
> proof-of-concept. Pilot offer: 60 days, no cost, on live client data under
> BAA. Asset ask: $45K–$65K acquisition or $75/client/month licensing.
> Next priority: identify 3 billing company targets (suggest starting with
> Florida-based DME RCM firms given existing FAHCS research) and prepare
> outreach sequence using Assets/signal-cgm-pitch-v2-professional.md.
> Hypothesis H2 (April 13 PA gap) and H3 (CB urgency) still require
> discovery call validation per validation-hypotheses.md in Obsidian vault.

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*Generated: April 2026 | STTIL Solutions LLC | Signal*
*All figures from CMS, OIG, KFF primary sources — see individual files for citations*