Guide
Weekly A/R Review For Behavioral Health Practices: What To Check
A practical weekly A/R review for behavioral health practices: rejections, claim status, denials, aging, EFT and ERA reconciliation, ownership, and next actions.
Weekly Revenue Review
A useful A/R review doesn’t start with the total balance. It starts with movement. What did you bill this week, what got accepted, what got paid and what stopped? For everything still open, who has the next step and when is it due?
Review These Seven Areas Every Week
1. Charges, Payments, And Adjustments
Put this week next to the prior four. Look at charges entered, claims released, payer payments, patient payments, contractual adjustments, refunds and unapplied cash. When A/R rises, the cause could be slower payment, missing charges, weak posting or a sudden adjustment pattern, and the total by itself won’t tell you which.
2. Claims That Never Reached Adjudication
Keep your clearinghouse and front-end rejections apart from payer denials. A rejected claim never finished adjudication. It usually needs corrected data, an enrollment fix, a format fix or different routing before it can go back out, and until it does, that money isn’t even in the payer’s queue. For each one, track the rejection reason, who owns the correction, the date it was corrected and the acceptance confirmation.
3. Claims Without A Current Status
Don’t let “submitted” turn into a permanent status. CMS names the standard 276 transaction as the claim-status request and the 277 as the response, so there’s a real mechanism for asking. Whether it comes from your billing system, the clearinghouse, a payer portal or your billing team, every unresolved claim should carry a dated status and a next step.
4. Denials, Zero-Pay Claims, And Underpayments
Group repeat issues by payer, provider, location, service, denial reason and the step they came from. The electronic remittance advice follows the X12 835 standard and carries the adjustment detail. On each one, look at the claim adjustment group code, the reason code, the remark code, the allowed and paid amounts, and the next filing or appeal deadline. Miss that last one and a fixable claim turns into a write-off you can’t recover.
5. Add An Action View To Your Aging Report
Keep the familiar 0-30, 31-60, 61-90, 91-120 and over-120-day buckets. Then put an action view on top of them. Every material balance should be waiting on something you can name, whether that’s a payer response, a correction, an appeal, a documentation item, a coordination-of-benefits step, a patient action or a management decision. “In follow-up” isn’t specific enough.
6. Ownership And Deadlines
Every open item needs one name and a next step with a due date on it. Look at your own overdue work separately from time spent waiting on a payer. The payer controls how fast it responds. What’s yours is the rest of the timeline: when status was last checked, when the correction went out, when the appeal was filed, and when the next escalation is due.
7. EFT, ERA, And Deposit Reconciliation
EFT is the money landing in the bank. The ERA explains the payments and adjustments claim by claim. They’re related, but each is its own setup and its own control, so one can be working while the other is broken. Tie deposits to remittances, then remittances to posted claims. CMS notes that ERA can support automated posting and gives more detailed adjustment information than a standard paper remittance.
A 20-Minute Weekly Owner Agenda
- Five minutes. Charges, payments, adjustments, deposits and total A/R movement.
- Five minutes. Anything new on the rejection, denial, zero-pay or underpayment side.
- Five minutes. The largest and oldest balances that don’t have a current documented action.
- Five minutes. Who’s on it and when it’s due, for every stuck claim, escalation, correction and appeal.
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 don’t 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
Want Us To Run This Review For You?
Ongoing Billing covers it. We run the weekly review, work the rejections, denials and underpayments, and send you the report above every week. Pricing goes by practice size, and claims already past 90 days can go to Billing Cleanup And A/R Recovery, where you pay 20% of what we collect and nothing on claims we don’t collect.