What A Behavioral Health Practice Owner Should Review In A/R Every Week

Weekly Revenue Review

A useful A/R review does not begin with the total balance. It begins with movement: what was billed, what was accepted, what was paid, what stopped, who owns the next action, and when that action is due.

Review These Seven Areas Every Week

1. Charges, Payments, And Adjustments

Start with this week compared with the prior four weeks. Review charges entered, claims released, payer payments, patient payments, contractual adjustments, refunds, and unapplied cash. A rising A/R balance can come from slower payment, missing charges, weak posting, or a sudden adjustment pattern. The total alone does not tell you which one.

2. Claims That Never Reached Adjudication

Separate clearinghouse and front-end rejections from payer denials. Rejected claims have not completed adjudication and usually need corrected data, enrollment, format, or routing before resubmission. Track the rejection reason, correction owner, corrected date, and acceptance confirmation.

3. Claims Without A Current Status

Do not let “submitted” become a permanent status. CMS identifies the standard 276 transaction as a claim-status request and the 277 as the response. Your billing system, clearinghouse, payer portal, or billing team should produce a dated status and a next step for claims that have not resolved.

4. Denials, Zero-Pay Claims, And Underpayments

Group repeat issues by payer, provider, location, service, denial reason, and workflow source. The electronic remittance advice uses the X12 835 standard and includes adjustment information. Review the claim adjustment group code, claim adjustment reason code, remittance advice remark code, allowed amount, paid amount, and next filing or appeal deadline.

5. Aging By Action, Not Only By Bucket

Keep the familiar 0 to 30, 31 to 60, 61 to 90, 91 to 120, and over-120-day views, but add an action view. Each material balance should be waiting on a named payer response, correction, appeal, documentation item, coordination-of-benefits step, patient action, or management decision. “In follow-up” is not specific enough.

6. Ownership And Deadlines

Every open item needs one owner, one next action, and one due date. Review overdue work separately from payer processing time. A payer may control its response time; your practice still controls when the status was checked, when a correction was sent, when an appeal was filed, and when the next escalation occurs.

7. EFT, ERA, And Deposit Reconciliation

EFT moves money to the bank. ERA explains claim payment and adjustments. They are related, but they are not the same setup or the same control. Reconcile deposits to remittances and remittances to posted claims. CMS notes that ERA can support automated posting and provides more detailed adjustment information than a standard paper remittance.

A 20-Minute Weekly Owner Agenda

1. Five minutes: Review charges, payments, adjustments, deposits, and total A/R movement.
2. Five minutes: Review new rejections, denials, zero-pay claims, and underpayments.
3. Five minutes: Review the largest and oldest balances without a current documented action.
4. Five minutes: Assign owners and deadlines for exceptions, escalations, corrections, and appeals.

What The Weekly Report Should Show

• Beginning and ending A/R, with weekly net movement.
• Charges, payments, adjustments, refunds, and unapplied cash.
• First-pass acceptance and rejection counts.
• Denials and zero-pay claims by reason and source.
• Aging by payer, provider, location, and action status.
• Largest balances and oldest balances with named owners.
• Appeal and timely-filing deadlines.
• EFT deposits that do not reconcile to ERA and posted claims.

Official Sources

• CMS: Claim Status Request and Response
• CMS: Adopted Transaction Standards and Operating Rules
• CMS: Health Care Payment and Remittance Advice