A busy family practice can finish the month with a full appointment book and still have unanswered billing questions. Which visits have not reached claim submission? Which errors keep returning? Where should the manager focus next?
A short monthly review gives those questions a regular place on the calendar. With reports prepared beforehand, try a 20-minute meeting built around three measures and one workflow change.
Start with a consistent view
Use three minutes to confirm the reporting period, report definitions, and any changes in visit volume, payer mix, staffing, or software. Keep those definitions the same each month so a reporting change does not look like an operational improvement.
The measures below are a practical starting point for your own scorecard, not required payer benchmarks. Compare your practice with its previous results before deciding what needs attention.
1. Completed visits still waiting for a claim
Spend four minutes reviewing the number of completed, insurance-billable encounters that had no initial claim submitted as of month-end. Include older encounters still waiting, not just visits from the latest month. Exclude canceled appointments and services your team has confirmed do not require an insurance claim.
Ask what is holding these encounters: an unfinished note, an unresolved coding question, or another missing step? Use your authorized practice system to examine examples, then summarize the reasons without patient identifiers on the manager's scorecard.
This measure keeps work that has not yet become a claim visible. Do not rush unsupported claims out simply to lower the count.
2. First-submission rejection share
Use the next four minutes to review initial claim submissions rejected at a clearly defined reporting stage, such as the payer's acceptance response. Divide rejected initial submissions by all initial submissions with a known acceptance or rejection response at that same stage and for the same reporting period. Count each claim once, and flag pending responses separately.
Keep this separate from adjudicated denials. For example, Noridian explains that a rejected Medicare claim may never enter the processing system because information is missing or invalid. The correction path matters. Read Noridian's claim-submission guidance.
Identify the recurring reason worth investigating. A repeated field error may point to a registration or system-mapping issue that needs one consistent fix.
3. Denials on initial payer decisions
Spend four minutes on claims initially adjudicated during the month. For this scorecard, calculate the share with at least one denied service line, counting each claim once. Use all claims initially adjudicated in that same period as the denominator. Keep later adjustments and reversals separate.
This is a different population from claims submitted during the month. Mixing those two groups can make the result misleading.
Review the payer's explanation before assigning a cause. Medicare remittance advice can include group codes, Claim Adjustment Reason Codes, and Remittance Advice Remark Codes. Adjustments also include items other than denials, so a zero payment or adjustment code alone is not your denial definition. CMS explains remittance advice and adjustment codes.
Protect deadlines between meetings
A monthly review does not replace daily work on time-sensitive claims. Keep the applicable submission, correction, and appeal deadlines visible in the team's regular work queues.
Medicare's initial filing rules and first-level appeal rules use different deadlines and starting points. Verify the current instructions for the specific payer, plan, and action instead of applying one deadline across the practice. See CMS timely-filing guidance and first-level appeal guidance.
Finish with one owned change
Use the final five minutes to choose one recurring problem the team can address. Record the problem, the workflow change, one responsible owner, and the date you will check it.
For example, if coding questions repeatedly sit without an assigned reviewer, establish a named review queue and a backup owner. At the next monthly meeting, check whether that same hold reason still appears and whether the change created another delay.
Keep the decision small enough to follow through. The value of the meeting is a clear next step that the team can recognize and review.
Want another perspective on your practice's billing challenges? Start with Matrix Medical Billing's Free A/R & Denial Snapshot.
Please do not submit patient names, records, claim screenshots, or other protected health information. This article is general operational education; follow current payer requirements and your practice's policies.
