Signal — Master Summary
Strategic Analysis Package | STTIL Solutions LLC | April 2026
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) |
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%
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) |
Leverage Priority Stack (Workflow Intervention Points)
- Prior Authorization (9.2/10) — Only denial type with zero recovery path
- Refill Tracking / Coverage Clock (8.8/10) — Enabling infrastructure for everything
- 6-Month Visit Compliance (8.1/10) — Highest-frequency daily queue driver
- PECOS Validation at Each Refill (7.4/10) — Hard write-off prevention
- Intake Validation (6.5/10) — Front-door pipeline defense
- Audit Defense Log (5.8/10) — Compliance record as system byproduct
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
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 |
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.
Generated: April 2026 | STTIL Solutions LLC | Signal
All figures from CMS, OIG, KFF primary sources — see individual files for citations
