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Billing review preparation checklist
A practical way to prepare an administrative conversation about accounts receivable, claim rejections, workflow ownership, and next actions—without emailing patient information.
Before you start: Use aggregate or de-identified information only. Do not include patient names, dates of birth, member IDs, claim numbers, screenshots, records, or other patient information in email or this checklist. If detailed review is needed, arrange appropriate secure access first.
1. Describe the practice at a high level
Enough context to understand the work—without a patient list.
- Services and locationsList the service types, care setting, and state(s) where you operate.
- Billing systems and access rolesName the EHR, practice-management, clearinghouse, and payer portals in use; note roles, not credentials.
- Payer mixIdentify the main payer categories or payers by approximate share of billing activity.
2. Bring an aggregate A/R picture
Focus on the size and age of the work, not individual accounts.
- A/R totals by aging bandFor example: current, 31–60, 61–90, 91–120, and 120+ days, using your normal reporting date.
- A/R by payer or payer categoryNote where the largest balances or oldest balances sit in aggregate.
- Recent activity volumeApproximate monthly claim submissions, payments, denials, and adjustments if available.
3. Identify claim rejection and denial themes
Summarize recurring patterns; do not forward individual EOBs, claim images, or patient correspondence by email.
- Top recurring messagesList general categories, such as demographic mismatch, authorization question, timely filing, coding edit, or enrollment issue.
- Where each issue occursNote the payer, service category, period, or workflow step involved in aggregate.
- What has already been triedCapture the general correction, appeal, portal inquiry, or follow-up already completed.
4. Map workflow ownership
A simple owner map makes it easier to see what can move next.
- Before submissionWho verifies eligibility, obtains authorizations, checks charge entry, and resolves missing information?
- After submissionWho monitors acknowledgments, rejection queues, denials, payer messages, and requests for information?
- Payment and reportingWho posts or reconciles remittances, investigates discrepancies, and communicates outstanding work?
- Decision contactName the administrative contact who can clarify workflow and approve agreed next steps.
5. Define the review question
Choose the first area where a clear next action would help most.
- What is stuck?Examples: an aging A/R segment, recurring rejection pattern, unclear handoff, unreconciled payment activity, or access/process gap.
- What would a useful outcome look like?Describe a workflow decision, prioritized work list, ownership clarification, or scoped next step—not a guaranteed collection result.
- What needs confirmation?List payer, contract, system, access, or internal-policy questions that need verification before action.