A report you cannot act on is just a file. The useful question in revenue cycle reporting is never what the number is; it is what changed, why it changed and what is being done about it. Our reporting pulls every figure from your own practice management system, sets it beside last week's and last month's, and comes with a named account manager who is expected to have traced the movement before the call, not during it.
What arrives each week
The weekly pack covers charges entered, claims submitted and accepted at the clearinghouse, payments posted from 835 remittances and paper EOBs, the aging report by bucket and by payer, and denials received and resolved by reason code, each with the same figure from the previous week beside it. It lists open items: unapplied cash, 277CA rejections waiting on information from you, coding queries waiting on a provider, authorizations pending and claims within 30 days of a filing deadline. It is written in plain language rather than exported as forty columns, and it is short enough to read before clinic.
The four numbers that matter
Days in A/R is total insurance and patient A/R divided by average daily charges, and it tells you whether cash is keeping pace with work. The share of A/R over 90 days tells you whether A/R follow-up is working the old buckets or letting them age into CO-29 timely filing write-offs. Net collection rate compares what was collected with what the contracts allowed after CO-45 contractual adjustments, and a low figure points at underpayments or unappealed denials rather than at contracts. Denial rate by reason code, split by payer, shows where the process leaks: CO-16 and CO-22 at registration, CO-4 and CO-97 in coding, CO-197 in authorization. Each is reported with its trend, because a single month tells you almost nothing.
Trends by reason code and payer
The denial section is not a total. It is a table of CARC codes by payer with volume and dollars, this month against the previous three, and a line naming the upstream source of each recurring code. A rising CO-97 count on one payer usually means an NCCI edit change or a modifier 59 policy update, and the report says so. A cluster of PR-204 non-covered denials on a new code means a benefit check is being skipped. First-pass acceptance at the clearinghouse and first-pass payment by the payer are tracked separately, because a claim can clear the clearinghouse and still deny.
Money you owe, not just money owed to you
Credit balances are on every report. Duplicate payments, both payers paying as primary and posting errors create overpayments, and Medicare overpayments have to be reported and returned within 60 days of being identified under 42 CFR 401.305. The pack lists credits by payer and patient with the cause and the refund due, so refunds go out on your schedule rather than after a payer audit. Unapplied cash, meaning EFT deposits without a matched 835, is listed with its age, because a deposit nobody has posted is revenue nobody has reconciled.
The monthly review
The monthly call goes through collections against charges, the aging trend, the denial trend by source, credentialing and revalidation dates coming due, payer contract anniversaries and any recommended write-offs with a reason on every line. Each month's pack is built the same way as the last so the numbers can be compared, and every figure comes from your system, where you can check it. Actions from the call are listed with an owner and a date, and the next month's pack opens with whether they were done.
How to tell whether a report is telling you anything
If your current report is a system export with no commentary, it is a file rather than a report. If it shows this month but not last month, it cannot show a trend. If the denial figure is a single total rather than a breakdown by reason code and payer, it cannot tell you what to fix. If a number moves and nobody can explain why on the call, the report is being produced but not read. If credit balances never appear, someone has decided you do not need to know about them. And if the figures come from the vendor's system rather than yours, you cannot verify them. Good revenue cycle reporting is boring in the right way: the same layout each week, the changes explained, the actions listed. The free billing audit produces a first version of this pack from your last 90 days of data.
What Is Included
- Weekly collections and charges summary
- Aging by bucket and payer with deadline flags
- Denial trends by CARC and RARC code
- Net collection rate against contracted allowed amounts
- Credit balances and refunds due
- A named account manager who explains the movement
| Remittance standard | Operating rules for electronic funds transfer and the 835 remittance became mandatory on January 1, 2014, including reassociation of payment and remittanceSource: CMS, Operating Rules for EFT and Remittance Advice |
|---|---|
| Overpayment refunds | An identified Medicare overpayment must be reported and returned within 60 daysSource: 42 CFR 401.305 |
Revenue Cycle Reporting: Common Questions
Within reason, yes. Tell us what your practice actually reviews and we will report against that rather than sending a template you ignore. The underlying figures stay the same so the trend is not broken by a format change.
Always. Billing runs in your practice management system, so every figure in the report can be checked by running the same report yourself. Nothing lives in a vendor system you cannot open.
As often as you need. A standing monthly review is typical, the weekly pack arrives on a fixed day, and the account manager is reachable by phone and email between reviews.
Yes. Where your practice management system records the rendering provider and the location on each claim, collections, aging and denials can be cut by either, and most multi-provider practices ask for it.
Days in A/R, the share of A/R over 90 days, net collection rate and denial rate by reason code. Those four tell you whether claims are going out, whether they are being paid correctly and whether anyone is fixing what comes back. Everything else explains those four.
The report covers the parts of the cycle we run. Where your own staff handle a step, such as front-desk collections, we report the figures your system shows for it, so the picture is complete rather than partial.