> ## Documentation Index
> Fetch the complete documentation index at: https://mso.getlemma.com/llms.txt
> Use this file to discover all available pages before exploring further.

# Weeks 1–4: Build the billing rhythm

> Stand up the daily and weekly billing cadences with concrete checklists, assign owners, and define the first dashboard.

In your first four weeks of live billing, you are not optimizing revenue — you are building **habits that hold when volume triples**. This tutorial installs the daily and weekly checklists, assigns owners, and gets your first dashboard in place.

## What Meridian did

Alex wrote the daily checklist on a shared doc in week one and required the biller to time-stamp each item. It felt like overkill at eight visits a day. In month four, at forty visits a day with two clinicians, the same checklist was the reason Meridian's clean claim rate never dropped below 94%.

## Week 1: install the daily loop

Assign every item an owner by name, not by role.

### Morning (30 minutes)

* [ ] Pull tomorrow's schedule; run **eligibility (270/271)** on every patient
* [ ] Flag coverage problems and have the front desk call those patients today
* [ ] Flag services needing **prior authorization**; start the requests
* [ ] Check the clearinghouse for overnight **999 / 277CA rejections**
* [ ] Work every rejection to resubmission **before touching anything else**

Rejections first, always. They are the cheapest problems you will ever fix and they expire.

### Afternoon (60 minutes)

* [ ] Enter charges for **yesterday's** completed visits
* [ ] Confirm every completed visit has either a charge or a documented reason it doesn't
* [ ] Run the scrubber; clear every edit
* [ ] Submit the batch
* [ ] Post any **835s** received; work the exception queue
* [ ] Confirm each deposit ties to its remittance via **TRN**

### End of day (10 minutes)

* [ ] Record the day's numbers: visits, charges entered, claims submitted, rejections, payments posted
* [ ] Note anything unresolved for tomorrow

<Tip>
  **The unbilled encounter report is your most important daily number.** Any completed visit without a charge is revenue that may never exist. Get it to zero every day, and it stays at zero. Let it run for two weeks and it becomes a project.
</Tip>

## Week 2: install the weekly loop

Pick a fixed day. Meridian used Tuesday.

* [ ] **Denial queue**, triage everything new by CARC group; nothing older than 14 days untouched
* [ ] **AR aging**, review the 60+ bucket line by line, the 90+ bucket with the ops lead
* [ ] **Credit balances**, review the report; anything over 30 days gets resolved
* [ ] **Credentialing grid**, update statuses; call any payer silent for two weeks
* [ ] **Patient balances**, confirm statements went out on schedule
* [ ] **Root-cause tagging**, for each denial worked, record *why it happened*, not just how it was fixed

That last item is what converts a denial queue into a management system. See [Work the denial queue](/guides/billing/work-the-denial-queue).

## Week 3: build the dashboard

You need one page, updated weekly. Six numbers and one table.

| Metric              | Source                           | Target        |
| ------------------- | -------------------------------- | ------------- |
| Clean claim rate    | Clearinghouse acceptance reports | 95%+          |
| Days in AR          | PM system                        | Trending down |
| Denial rate         | 835 data                         | Under 5–10%   |
| Net collection rate | PM system                        | 95%+          |
| AR over 90 days     | AR aging                         | Under 15–20%  |
| Unbilled encounters | PM system                        | 0             |

Plus a table of **denials by CARC**, sorted by dollar value. That table tells you what to fix next, every week, without any judgment call.

Track each metric **by payer** as soon as you have more than one.

## Week 4: close the prevention loop

The mechanism that separates practices that improve from practices that just keep working:

<Steps>
  <Step title="Tag every denial with a root cause">
    Use a fixed taxonomy: eligibility, authorization, coding, credentialing, timely filing, coordination of benefits, documentation, demographic error. Free text defeats the purpose.
  </Step>

  <Step title="Rank causes by dollars, weekly">
    Not by count. Ten $40 denials matter less than one $900 denial.
  </Step>

  <Step title="Change one upstream process">
    One per week. If eligibility failures top the list, add a second verification at check-in. If authorization failures top it, build the auth-required list per payer into the scheduling workflow.
  </Step>

  <Step title="Verify next week">
    Did that cause drop? If not, the fix didn't work — change something else rather than adding a second layer to a failed one.
  </Step>
</Steps>

Prevention economics are stark: reworking a denied claim costs materially more than preventing it, and a meaningful share of denied claims are simply never reworked at all. See [Claim denials, explained](/concepts/payments/claim-denials).

## Documenting who does what

Write it down, because your first biller will not be your only biller.

| Function                 | Owner                           | Backup             |
| ------------------------ | ------------------------------- | ------------------ |
| Eligibility verification | Front desk                      | Biller             |
| Point-of-care collection | Front desk                      | —                  |
| Charge entry             | Biller                          | Ops lead           |
| Claim submission         | Biller                          | Ops lead           |
| Rejection resolution     | Biller                          | Ops lead           |
| Payment posting          | Biller                          | Bookkeeper         |
| Denial appeals           | Biller                          | Outsourced partner |
| Patient statements       | Biller                          | —                  |
| **Code assignment**      | **Clinician / certified coder** | —                  |

Keep the last row's boundary clear. Billing staff are MSO employees; **coding decisions belong to the PC.** The MSO provides the people and the systems; it does not determine what diagnosis or procedure codes are assigned. California's SB 351 names billing and coding among the functions a management entity may not control.<sup>1</sup> See [Run a CPOM self-audit](/guides/compliance/run-a-cpom-self-audit).

## What good looks like at day 30

* Zero unbilled encounters older than two business days
* Every 277CA rejection worked the day it arrives
* A denial queue with a named owner and nothing older than 14 days
* A weekly dashboard someone actually reads
* At least one upstream process changed because of denial data

## Next

<Card title="Your first denial" icon="arrow-right" href="/start/first-90-days/work-your-first-denial">
  A CO-197 arrives. Walk it through end to end.
</Card>

## Sources

1. Cal. S.B. 351 (2025), effective January 1, 2026. Summary: Quarles, [California Cracks Down: New Laws Governing the Corporate Practice of Medicine and PE Deals](https://www.quarles.com/newsroom/publications/california-cracks-down-new-laws-governing-the-corporate-practice-of-medicine-and-pe-deals).


## Related topics

- [Submit clean claims](/guides/billing/submit-clean-claims.md)
- [Post payments from 835s](/guides/billing/post-payments-from-835s.md)
- [Hire your first biller](/guides/billing/hire-a-biller.md)
- [What billers actually do](/concepts/payments/what-billers-do.md)
- [Denial code playbook](/reference/edi/denial-code-playbook.md)
- [CARC codes (Claim Adjustment Reason Codes)](/reference/edi/carc-codes.md)