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THIS WEEK IN PRACTICE |
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Two weeks in and a theme is emerging from your replies: denial management and patient collections are consuming the most energy. We’ll keep coming back to both. This week we’re covering your EHR — specifically the settings most practices either never set up or set up wrong, and that cost real money in the form of missed claims, manual work that should be automated, and denial patterns your system could be catching before submission. |
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DEEP DIVE | ||||||||||||||||
Your EHR Is Doing Less Work Than It Should Be | ||||||||||||||||
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The average independent practice uses roughly 40% of the capabilities built into their EHR and billing platform. The features they’re not using aren’t cosmetic — they’re the clearinghouse scrubbing rules, the eligibility verification automation, the denial analytics, and the payment posting exception workflows that exist precisely to reduce manual billing work and catch errors before they become denials. Here is what this looks like in practice. A 4-provider internal medicine practice discovered their EHR had real-time eligibility verification available but never activated. They were verifying insurance manually at check-in — catching about 70% of issues. After activating auto-verification at scheduling (a 10-minute configuration change), their CO-27 (patient not eligible) denials dropped from $3,400/month to under $400/month within 60 days. One setting. $36,000 in annual recovered revenue.
That table is your entire denial management strategy on one page. Pin it to your wall, share it in your Monday billing meeting, and update it on the first of every month. The reason most practices underuse their EHR is not that the features are hidden. It is that EHRs are implemented under time pressure, the initial training covers core workflow and stops there, and nobody on the billing team has had dedicated time to explore what else the system can do. The advanced features get deferred and never revisited. The five settings that make the biggest practical difference are almost universally under-configured: Eligibility verification automation — most EHRs can run eligibility checks automatically the day before scheduled appointments. This is almost never turned on by default, and almost never configured after implementation. The result: staff running manual verification checks one patient at a time, or not running them at all. Claim scrubbing rule sets — clearinghouses include edits that flag claims with common errors before the claim leaves your system. The default rule set catches major errors. Custom rule sets, configured for your payer mix and specialty, catch the ones that will actually get denied. Denial code workflows — most billing systems can automatically assign denied claims to a worklist based on reason code, route them to the right staff member, and set a follow-up date. Without this, denied claims land in a generic queue worked in whatever order someone picks them up — which is often the wrong order. ERA auto-posting thresholds — Electronic Remittance Advice can post payments automatically within configurable tolerance limits. Most practices either set this too tight (manual review of almost everything) or too loose (automatic posting of payments that should be disputed). Reporting dashboards — virtually every modern billing system includes a dashboard showing denial rate, Days in AR, and clean claim rate. Most practice managers have never configured these or set target thresholds. The system will tell you when your denial rate is trending up — if you tell it what to look for. |
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THREE ACTION STEPS THIS WEEK | ||
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Complete each step before next Tuesday. | ||
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FIVE THINGS WORTH KNOWING | ||||||||||
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BILLING CORNER | |
How to Use Your Clearinghouse Rejection Report to | |
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Your clearinghouse generates a rejection report every time a batch of claims is submitted. Most billing teams look at individual rejected claims and fix them. Fewer look at the patterns across rejections — which is where the real diagnostic information lives.
Step 1: Set up a weekly clearinghouse report review. In your clearinghouse portal, look for the rejection summary or edit report — the aggregate, not the individual claim list. Step 2: Look for edits that appear more than 3 times in a week. A single claim rejected for a missing modifier is a one-time fix. Five claims rejected for the same missing modifier in one week is a workflow problem. Step 3: For any edit appearing 3+ times, trace it to the source. Is it a specific provider? A specific CPT code? A specific payer? A specific staff member handling charge entry? Step 4: Fix the source, not just the claims. Update the charge entry template. Add the modifier to the fee schedule default. Contact the provider about the documentation gap. Step 5: Check the same edit category the following week. If it drops off, the fix worked. If it persists, you missed the root cause. This process takes 20 minutes per week and prevents the majority of repeat rejections that silently inflate denial rates month after month. |
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COMPLIANCE WATCH | |
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PEOPLE & PRACTICE |
The Remote Work Question for Billing Staff |
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Most billing functions can be performed remotely. The question is whether your practice manages remote billing staff well enough to sustain the performance you’d get in-office. Practices that manage remote billing effectively share three characteristics: they measure outputs (claims submitted, denials worked, AR metrics) rather than inputs (hours logged); they maintain a daily or weekly standing check-in that is genuinely brief and action-oriented; and they invest in shared tooling so remote staff aren’t isolated from information the in-office team has. Practices that manage remote billing poorly do the opposite: they try to monitor activity instead of measuring results, skip regular check-ins, and allow information silos to form between front desk and billing. The billing function is well-suited to remote work. The management question is the actual variable. |
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ASK THE PULSE | ||||||
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ONE MORE THING |
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The most common EHR support request across all major billing platforms in 2024 was ’how do I run a denial report.’ The second most common was ’where do I find my open claims.’ Both answers are in the same section of every billing platform’s help center — and both are questions that a 15-minute onboarding session with a new billing hire would answer permanently. Documentation gaps in billing staff training cost more than the training would. Build the 15-minute EHR orientation into your onboarding process and never skip it. |
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The Practice Pulse · Issue 03 · Every Tuesday at 7 AM |