How to Improve Billing Accuracy

𝑺𝒉𝒂𝒓𝒊𝒏𝒈 𝒇𝒓𝒐𝒎 𝒎𝒚 𝒑𝒂𝒔𝒕 𝒆𝒙𝒑𝒆𝒓𝒊𝒆𝒏𝒄𝒆: While working with a Texas-based Primary Care Physician group, I faced a familiar yet costly challenge- 𝗿𝗶𝘀𝗶𝗻𝗴 𝗱𝗲𝗻𝗶𝗮𝗹 𝗿𝗮𝘁𝗲𝘀 𝗮𝗻𝗱 𝗮 𝗹𝗼𝘄 𝗳𝗶𝗿𝘀𝘁-𝗽𝗮𝘀𝘀 𝗿𝗲𝘀𝗼𝗹𝘂𝘁𝗶𝗼𝗻 (𝗙𝗣𝗥). Like many organizations, our initial focus was on back-end fixes i.e. coding audits, billing edits, and payer follow-ups. But the real breakthrough came when we reframed the question: “𝗪𝗵𝗲𝗿𝗲 𝗶𝘀 𝘁𝗵𝗲 𝗽𝗿𝗼𝗰𝗲𝘀𝘀 𝗯𝗿𝗲𝗮𝗸𝗶𝗻𝗴 𝗱𝗼𝘄𝗻?” The answer was clear: 𝘁𝗵𝗲 𝗳𝗿𝗼𝗻𝘁 𝗲𝗻𝗱. We redesigned our intake and pre-visit workflows, and within a few months, significantly reduced denials while improving 𝗙𝗣𝗥 𝘁𝗼 𝟵𝟴%.. 𝐖𝐡𝐚𝐭 𝐝𝐫𝐨𝐯𝐞 𝐭𝐡𝐞 𝐜𝐡𝐚𝐧𝐠𝐞: 🔹 𝗦𝘁𝗿𝗮𝘁𝗲𝗴𝗶𝗰 𝗣𝗮𝘁𝗶𝗲𝗻𝘁 𝗦𝗰𝗵𝗲𝗱𝘂𝗹𝗶𝗻𝗴 Aligned appointments with payer guidelines, visit types, and provider credentialing. Integrated digital scheduling with EMR/EHR and strengthened front-desk processes to reduce downstream errors. 🔹 𝗔𝗰𝗰𝘂𝗿𝗮𝘁𝗲 & 𝗧𝗶𝗺𝗲𝗹𝘆 𝗘𝗹𝗶𝗴𝗶𝗯𝗶𝗹𝗶𝘁𝘆 𝗩𝗲𝗿𝗶𝗳𝗶𝗰𝗮𝘁𝗶𝗼𝗻 (𝗘𝗩) & 𝗩𝗢𝗕 Implemented a structured, multi-layer verification process—validating active coverage, PCP attribution, copays, deductibles, referrals, and service-specific limitations prior to the visit. Timely execution ensured accuracy while allowing teams to proactively resolve discrepancies. 👉 𝘛𝘩𝘪𝘴 𝘢𝘭𝘰𝘯𝘦 𝘳𝘦𝘮𝘰𝘷𝘦𝘥 𝘢 𝘴𝘶𝘣𝘴𝘵𝘢𝘯𝘵𝘪𝘢𝘭 𝘷𝘰𝘭𝘶𝘮𝘦 𝘰𝘧 𝘱𝘳𝘦𝘷𝘦𝘯𝘵𝘢𝘣𝘭𝘦 𝘥𝘦𝘯𝘪𝘢𝘭𝘴. 🔹 𝗥𝗼𝗯𝘂𝘀𝘁 𝗣𝗿𝗶𝗼𝗿 𝗔𝘂𝘁𝗵𝗼𝗿𝗶𝘇𝗮𝘁𝗶𝗼𝗻 𝗪𝗼𝗿𝗸𝗳𝗹𝗼𝘄 Established clear ownership and tracking for pre-visit authorizations, ensuring high-risk services were approved before the date of service. 🔹 𝗖𝗹𝗼𝘀𝗲𝗱-𝗟𝗼𝗼𝗽 𝗙𝗿𝗼𝗻𝘁 & 𝗕𝗮𝗰𝗸-𝗘𝗻𝗱 𝗔𝗹𝗶𝗴𝗻𝗺𝗲𝗻𝐭 Created continuous feedback loops where denial trends were analyzed and shared with front-end teams—addressing root causes, not just symptoms. 🚀 𝐈𝐦𝐩𝐚𝐜𝐭: ✔️ Significant reduction in denials and rejections ✔️ FPR improved to 98% ✔️ Lower rework and administrative overhead ✔️ Faster reimbursements and improved cash flow 𝐊𝐞𝐲 𝐭𝐚𝐤𝐞𝐚𝐰𝐚𝐲: ✅ Denial management is not a back-end function- it’s a front-end discipline. ✅ In today’s complex payer landscape, 𝗽𝗿𝗲𝗰𝗶𝘀𝗶𝗼𝗻 𝗮𝘁 𝘀𝗰𝗵𝗲𝗱𝘂𝗹𝗶𝗻𝗴, 𝗲𝗹𝗶𝗴𝗶𝗯𝗶𝗹𝗶𝘁𝘆, 𝗮𝗻𝗱 𝗶𝗻𝘁𝗮𝗸𝗲 𝗶𝘀 𝗻𝗼 𝗹𝗼𝗻𝗴𝗲𝗿 𝗼𝗽𝘁𝗶𝗼𝗻𝗮𝗹—𝗶𝘁’𝘀 𝗮 𝗰𝗼𝗿𝗲 𝗿𝗲𝘃𝗲𝗻𝘂𝗲 𝗽𝗿𝗼𝘁𝗲𝗰𝘁𝗶𝗼𝗻 𝘀𝘁𝗿𝗮𝘁𝗲𝗴𝘆 Would love to hear how others are strengthening their front-end processes to drive better financial outcomes. Altermed RCM #RCM #MedicalBilling #DenialManagement #RevenueCycleManagement #EligibilityVerification #PriorAuthorization #HealthcareOperations #USHealthcare #PracticeManagement

💡 Are We Underusing Our Coders? Too often, coding and billing teams get pegged to the “volume machine”—churning out codes all day without leveraging their true expertise. If you’ve got certified pros on your roster, here’s how to tap their full value: 1️⃣ Write Appeal Letters Coders know the clinical story behind every chart. Have them draft or review medical necessity appeals—those letters will sing when written by someone fluent in CPT/ICD-10. 2️⃣ Own Denial Workflows Zero-pay reports are full of coding denials. Train your coders on denial reasons and let them partner with billers to prevent repeat errors. It won’t break your revenue if the first few appeals miss the mark—ignoring root causes will. 3️⃣ Cross-Train to Close Gaps Rotate coders through billing and claims follow-up so they see the full cycle—from claim submission to remittance advice. Suddenly, everyone understands each other’s KPIs and inefficiencies start disappearing. 4️⃣ Champion Payer Policies Do your coders know your payers policy? From bundling edits to local coverage determination policies, coders should be your in-house policy gurus, guarding you from nasty surprises on the remittance. 5️⃣ Build Documentation Templates Coders know which documentation elements payers need. Pair them with your clinic teams and EMR trainers to design templates that hit every policy requirement—no more chasing missing “key” data. Managers with no coding or documentation background should lean on their coders to collaborate on EMR training and template design. If your team spends 8+ hours on one task, you’re missing out on wins across the revenue cycle. ❓ How are you empowering your coders beyond code selection?

Step 4 of the Revenue Cycle Management (RCM) process is here, and this is the part where accuracy becomes money. Coding & Charge Entry. The step that quietly decides whether your claims get paid… or denied. Let’s break it down in the simplest way possible. What Is Coding & Charge Entry? Coding is the process of converting provider documentation into standardized medical codes: - CPT - ICD-10 - HCPCS Charge Entry is the next step, entering those codes into the billing system with the correct fees, modifiers, and patient information. Think of it like translating a provider’s work into a language insurance understands. If the translation is wrong… the payment won’t come. Why This Step Is So Important Accurate coding leads to: ✅Clean claims ✅Faster reimbursements ✅ Fewer denials ✅Strong compliance ✅Accurate reporting ✅Transparent patient billing One wrong code can delay payment for weeks. One missing modifier can trigger an instant denial. One documentation gap can cause revenue leakage. This is the step where precision pays , literally. 📌 Example A patient comes in for a simple wound repair. The provider documents: - 2.5 cm laceration - Simple closure - Local anesthesia Correct code: 12001 But if someone mistakenly enters 12002 (intermediate repair), insurance will deny it. Not because the work wasn’t done… But because the code doesn’t match the documentation. This is why Coding & Charge Entry must be clean, accurate, and detail-driven. 🛠️ How a Virtual Medical Assistant Helps A skilled VMA supports providers by: ✅Reviewing documentation ✅Assigning accurate codes ✅Checking payer-specific rules ✅Ensuring correct modifiers ✅Preparing clean charges ✅Flagging missing information ✅Coordinating with billers and providers Result: 📌Fewer denials. 📌Faster payments. 📌Better patient experience. 📌Stronger revenue flow. If Step 3 is about capturing what happened, Step 4 is about converting it into revenue. And in a busy practice, accuracy is everything. If you’d like help improving your coding and charge entry workflow, I’m here to support your team with reliable, detail-driven assistance.

Many companies running Microsoft Dynamics 365 still miss some key facts about subscription billing efficiency. I've talked to hundreds of CFOs and controllers over 24 years, and the pattern is consistent: The ERP handles the core, but billing complexity gets managed in spreadsheets on the side. Here's how to audit and fix that yourself (no tools required): Step 1: List every billing exception your team handled last month. - Manual prorations, mid-cycle changes, multi-element contracts, usage overages. Every exception is a gap in your current setup. Step 2: Calculate the true cost of each exception. - Hours spent × fully-loaded labor cost. Most teams are shocked. It’s not unusual to uncover $40–80K/year in manual billing labor. Step 3: Identify your top 3 recurring exception types. - These are your highest-leverage automation targets. Don't try to fix everything at once. Step 4: Build a simple "exception rate" metric. - Track what % of invoices required manual intervention this month. Benchmark it. That number should be trending toward zero. Step 5: Document your ideal billing workflow. - Before buying anything, write down what "zero exceptions" looks like for your team. This becomes your evaluation criteria for any solution. If you do this and realize the problem is deeper than process — that your Dynamics environment simply doesn't support your billing model natively — that's exactly the problem Binary Stream's Subscription Billing solutions are built to solve. But either way, start with the audit. The clarity alone is worth it.

People overcomplicate billing systems. And when billing breaks down, trust disappears fast. A few weeks ago, I spoke with a new client who had just lost their biggest customer. Not because of poor service. Not because of pricing. But because of a billing error that went unnoticed for weeks. They didn’t just lose one client — they lost the referrals that would’ve come from that relationship. All from one small, avoidable mistake. If you’re a growing business owner, here’s what you need to know: Avoid: ❌ Chasing clients for payments manually ❌ Letting write-offs slip through the cracks ❌ Delaying invoices “until you have time” Instead: ✅ Automate invoicing and reminders ✅ Track time and expenses in real-time ✅ Reconcile monthly, not yearly Focus on this for the first 30 days. Build from there. Simple systems prevent expensive mistakes. And your reputation deserves that kind of protection. 👉 Make one change this week: automate just one part of your invoicing process. It’s a small move that builds long-term trust with every client you serve. You’ve worked too hard to let billing errors undo your momentum. And, your business and those who need you are depending on it. If this post hit the spot, please share! ♻️

Yesterday I talked about proactive AR and why the best teams prevent payment issues instead of just reacting to them. Today I want to talk about where a lot of those issues actually start. 👇 One bad invoice. Four downstream problems. 🚨 When an invoice goes out with an error on it, most people think the consequence is a delayed payment. That is the least of your problems. Here is what actually happens: 💸 The payment is delayed. The customer will not pay what they did not agree to and should not have to. ⏰ Your team's time gets consumed. Catch it, investigate it, correct it, reissue it, follow up. Hours of capacity gone on a problem that should never have existed. 😬 The customer relationship takes a hit. Nothing erodes trust faster than being billed incorrectly. Customers notice. And they remember. 📈 Your DSO goes up. Every day that invoice sits in dispute is a day added to your aging. At scale, the impact is significant. One error. Four problems. Every single time. Now here is the part most people do not want to hear. 👀 Most invoice errors do not start in billing. They start in the CPQ process. Incorrect pricing, wrong contract terms, mismatched configurations. By the time that deal makes it through signature and into your billing system, the error is already baked in. Billing is just where it finally becomes visible. Here is what the best OTC teams do about it: 1) 🔍 Treat Order Management as a quality gate, not just a provisioning step. 2) 🤝 Build a tight feedback loop between AR and the CPQ team. Bad data upstream needs to get flagged fast. 3) 📋 Standardize quoting structures wherever possible. Complexity creates errors. 4) 📊 Measure invoice accuracy and trace every error back to its source. The trail almost always leads back to the quote. Invoice accuracy is not just a billing problem. It is an end to end OTC problem that starts long before billing ever gets involved. Fix the root cause, not the symptom. 🎯 Drop your thoughts in the comments. Where are invoice errors showing up most in your OTC process? #InvoiceAccuracy #CPQ #InvoiceToCash #OrderToCash #AccountsReceivable #FinanceLeadership #BillingOperations

SAP Tip Friday (a bit late) When prices come out wrong on a billing document even though the sales order was correct, check the pricing type in copy control (VTFL) before you touch a single condition record. If the pricing type is set to "B" (carry out new pricing) instead of "D" (copy pricing elements unchanged) or "C" (copy manual + redetermine automatic), SAP silently re-runs the entire pricing procedure at billing using today's condition records, not the ones that applied when the order was placed. Quick diagnostic order: 1. Compare conditions on the sales order (VA02, Item → Conditions) against the billing doc (VF03, Item → Conditions) — if they don't match, it's a repricing issue, not a data issue 2. Check VTFL for the relevant item category → note the pricing type 3. If it's "B" and shouldn't be, decide whether "C" or "D" fits your business process (e.g. long lead-time orders usually want "D") 4. Watch out because this also affects rebate-relevant conditions if they're marked as recalculated at billing

Most revenue cycle problems don’t start in AR. They start quietly weeks earlier when claims sit in queues, data lives in spreadsheets, and no one can clearly explain why cash moves one month and stalls the next. Across many hospital environments we step into, the pattern is familiar. And last year, we encountered it again. On the surface, things looked stable. Underneath, the system was fragile. Claims were being batched instead of transmitted. Payments were tracked in Excel, not intelligence. Legacy AR was assumed dead, not worked. And cash flow fluctuated enough that forecasting felt more like guesswork than planning. The issue wasn’t effort. It was a lack of discipline, visibility, and ownership across the full revenue lifecycle. So we didn’t start by “working AR harder.” We fixed the front end. Claims began moving to payers within 48 hours, not weeks. Every clearinghouse edit was resolved before submission. Clean claims became the standard. Within two months, timely transmission improved from 88% to 91%, and second-month billing performance increased five points year over year. Then we turned to payments. Instead of asking “what paid,” we asked “what didn’t, and why?” Daily payment and denial monitoring replaced spreadsheets. Patterns emerged. Root causes became visible. Small improvements in early payment timing compounded into meaningful cash acceleration. Next came the work most teams underestimate. Legacy AR. Balances that had stalled weren’t uncollectible. They were unattended. With focused follow-up and denial intelligence, nearly $2.54M in older DOS AR was recovered including meaningful dollars from the prior year. The outcome was telling. Cash stopped swinging month to month. Average monthly hospital insurance cash stabilized from $2.6M to $3.0M. Forecasting became credible. Leadership conversations shifted from reaction to control. The lesson is one we continue to see across organizations: Revenue cycle improvement isn’t about heroics. It’s about removing friction early, turning payments into insight, and treating AR like a strategy not a backlog. For executives focused on predictability: How confident are you in your ability to forecast cash and how early in the revenue cycle do you really have control over that outcome?

CMS published a valuable and (surprisingly) easy to read fact sheet relevant to anyone in the mid-revenue cycle. Link to “Complying with Medical Record Documentation Requirements” below, along with a handy ACDIS recap. The fact sheet lays out four common sources of denial related to insufficient documentation. CDI, coding, and compliance professionals, take note. The fact sheet summarizes findings from the Comprehensive Error Rate Testing (CERT) program. When CERT requests a review, the billing provider must send supporting documentation (for example, physician’s order or notes to support medical necessity) from a referring physician’s office or from the hospital. That documentation is used to support the justification for the claim, and if it doesn’t, recoupments occur. Last year, Medicare FFS claims had an estimated 7.66% error rate per CERT, accounting for $31.7 billion (B, billion) in improper payments. What were the four most common sources of error? 1.       Evaluation & Management (E/M) Services: CERT identified office visits (established), hospital (initial), and hospital (subsequent) as the top three errors in E/M service categories. High errors included insufficient documentation, medical necessity, and incorrect coding of E/M services to support medical necessity and accurate billing of those services. 2.       Diagnostic Tests: CERT identified there was insufficient documentation to support medical necessity in the plan, or intent to order diagnostic tests. If the handwritten signature is illegible, include a signature log, CMS advises. 3.       Physical Therapy Services: CERT identified the documentation submitted by the physician or NPP didn’t support certification of the plan of care (POC). CERT requires the physician’s or NPP’s signature and date of certification of the POC, or progress note. 4.       Durable Medical Equipment (DME): Hospital beds, glucose monitors, and manual wheelchairs require a written order or prescription from the treating practitioner as a condition for payment, which must meet standard written order requirements. Many apparently did not. Other common sources of error noted in the fact sheet include: ·     Incomplete progress notes (for example, insufficient detail to support providing the service according to coverage requirements) ·     Medical records that fail to demonstrate authenticity or otherwise meet a signature requirement for payment (examples: no provider signature, no supervising signature, illegible signatures without a signature log or attestation to identify the signer) ·     No documentation of order or intent to order services and procedures if required by Medicare policy The ACDIS article below includes some great strategies for beefing up supporting documentation. Check it out. And share the fact sheet with your CDI, coding, and compliance teams. And don’t forget your John Hancock. I’m surprised signatures are still a problem … but there you have it.