A billing process is only as good as its weakest handoff. Most practices we speak with have competent people and an incomplete workflow, charges reviewed inconsistently, claims batched when convenient, denials worked when someone has room. Our job is to make the whole cycle predictable.
What the workflow actually looks like
Each day starts with the previous day's encounters: charges reviewed against the note, coding checked for obvious mismatches, missing information requested while the visit is still fresh. Claims leave daily. Remittances are posted within a couple of business days, and anything denied gets a reason category and an owner.
Weekly, we look at what is stuck rather than what is late. A claim held for a missing referral is a different problem from a claim denied for medical necessity, and they should never be worked in the same queue.
- Charge entry review and coding consistency checks
- Daily claim submission with clearinghouse rejection handling
- Electronic and manual payment posting with adjustment review
- Denial classification, follow-up, and appeal tracking
Reporting you can read in five minutes
We keep reports narrow on purpose: claim volume and status, first-pass acceptance, denials by reason and payer, A/R aging, and posting lag. If a report does not lead to a decision, it is not worth the space it takes.
Each review ends with one or two agreed actions. That constraint is deliberate, practices that try to fix everything at once usually fix nothing.
How the process runs
Every engagement follows the same five steps, adjusted to the service you choose. The point is not the checklist, it is that each step has an owner and a date, so nothing waits quietly.
- 1Documenting the current workflow and common exceptions
- 2Establishing ownership and priority for open items
- 3Tracking status, outcomes, and recurring reasons for delay
- 4Escalating issues that require provider or payer input
- 5Reviewing trends and agreeing on next actions