What you’re building
The principle: catch problems at the smallest possible scale. A rejection caught the same day costs five minutes. The same problem found at month-end close is a hundred claims and a week of archaeology.The daily rhythm
Charges should be entered within one business day of the visit. Every day of lag is a day added to days in AR and a day closer to timely filing limits.
The weekly rhythm
The rule that matters most: no denial sits untouched longer than 14 days. Appeal windows are short, and a denial you haven’t looked at is a denial you’re about to lose.
The monthly rhythm
Your first KPIs
Five numbers. Measure them from month one, even when the denominators are small, so you have a trend before you have a problem.Clean claim rate
Claims accepted on first submission without rejection or denial, divided by total claims submitted. Target: 95%+. Below 90% means something structural is wrong, usually enrollment data or eligibility discipline, not coding.Days in AR
Total accounts receivable divided by average daily charges. Target: under 40 days for most outpatient specialties; under 30 is strong. Watch the trend more than the level in your first six months, since a new practice’s AR is distorted by the ramp.Denial rate
Claim lines denied divided by claim lines adjudicated. Target: under 5–10%, specialty-dependent. More useful than the headline number is the breakdown by CARC, because that tells you which upstream process to fix. See Claim denials, explained.Net collection rate
Payments received divided by (charges minus contractual adjustments), that is, what you collected out of what you were entitled to collect. Target: 95%+. This is the number that catches quiet revenue leakage. A practice can have a great clean claim rate and still be at 88% net collection because it writes off patient balances, misses timely filing, or never appeals underpayments.Percentage of AR over 90 days
Target: under 15–20%. Money past 90 days is money you are unlikely to collect in full.What you’re not doing yet
Deliberately deferred past day 90 for most groups: value-based contracts, second-location expansion, in-house coding certification, custom analytics, and a second state. Build the rhythm first.The four tutorials in this section
Weeks 1–4: build the billing rhythm
Stand up the daily and weekly cadences with checklists.
Your first denial
A CO-197 arrives. Read it, fix it, prevent it.
Your first patient refund
A patient overpays. Detect, verify, refund, record.
Your first month-end close
Two entities, one reconciliation, no commingling.