> ## 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.
# Overview: from first claim to smooth operations
> The daily, weekly, and monthly rhythms that turn a working billing process into an operation, and the first KPIs worth measuring.
Getting paid once is a milestone. Getting paid reliably is a **rhythm**: a small set of things done daily, weekly, and monthly, in the same order, by named people. This tutorial builds that rhythm over your first 90 days.
## What you're building
```mermaid theme={null}
graph TB
D[Daily
eligibility · charge entry
payment posting · rejections]
W[Weekly
denial queue · AR review
credit balances · credentialing]
M[Monthly
close · reconciliation
management fee · KPIs]
D --> W --> M
```
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
| Task | Who | Time |
| --------------------------------------------- | ---------- | --------- |
| Verify eligibility for tomorrow's schedule | Front desk | 20–30 min |
| Collect copays and known balances at check-in | Front desk | Ongoing |
| Enter charges for yesterday's visits | Biller | 30–60 min |
| Clear scrubber edits and submit claims | Biller | 20 min |
| Work 999 / 277CA rejections, **same day** | Biller | 15 min |
| Post 835s and work the exception queue | Biller | 30 min |
| Confirm deposits match remittances | Biller | 15 min |
**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
| Task | Who | Cadence |
| --------------------------------------- | ----------------- | ------------------------- |
| Work the denial queue by CARC group | Biller | Twice weekly minimum |
| Review AR aging, focusing on 60+ days | Biller + ops lead | Weekly |
| Review the credit balance report | Biller | Weekly |
| Update the credentialing tracking grid | Ops | Weekly |
| Follow up on pending payer applications | Ops | Every two weeks per payer |
| Review unbilled encounters | Ops lead | Weekly |
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
| Task | Who |
| ------------------------------------------------------ | ------------------- |
| Close both entities' books | Bookkeeper |
| Reconcile posting totals ↔ 835s ↔ bank deposits | Biller + bookkeeper |
| MSO invoices the management fee; PC pays it | Ops / finance |
| Review KPIs against target | Leadership |
| Resolve aged credit balances and issue refunds | Biller |
| Check the compliance calendar for the coming 60 days | Ops |
| Run OIG LEIE and SAM.gov exclusion checks on all staff | Ops |
## 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](/concepts/payments/claim-denials).
### 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.
Track all five **per payer**, not just in aggregate. One payer with a 20% denial rate hidden inside a 6% blended average is a solvable problem you cannot see.
## 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
Stand up the daily and weekly cadences with checklists.
A CO-197 arrives. Read it, fix it, prevent it.
A patient overpays. Detect, verify, refund, record.
Two entities, one reconciliation, no commingling.
Then set up the [compliance calendar](/start/first-90-days/compliance-calendar) so the recurring obligations don't ambush you.
## Related topics
- [Work the denial queue](/guides/billing/work-the-denial-queue.md)
- [Reconcile payments daily](/guides/payments/reconcile-daily-payments.md)
- [Set up bookkeeping and consolidation](/guides/banking/set-up-bookkeeping.md)
- [What billers actually do](/concepts/payments/what-billers-do.md)
- [The life of a claim](/concepts/payments/claim-lifecycle.md)
- [Denial code playbook](/reference/edi/denial-code-playbook.md)