Run a month-end revenue review

For: Agency Owner · Time: 45–90 min · Frequency: Monthly (first business day after month-end)

Trigger

The month closed. You need to know: how much did each practice collect, how much do they owe us, what's our denial picture, and are any practices trending the wrong way.

Outcome

You have one document (Slack thread, doc, spreadsheet — your choice) per practice with: total collected, total billed, collection %, denial %, A/R aging shift vs last month, and your action for the next 30 days. You've also generated your invoices for your agency fees.

Where

• RCM Hub → A/R Aging tab
• Billing Services — Clients tab
• RCM Hub → Claims — filtered by date range
• Reports / Export — claim status export
• Billing → Invoices → Invoices

Steps

1. Pull total collections for the month. RCM → Claims, filter paid_at to last calendar month. Export to CSV. Sort by billing_client_id (practice). The sum per practice is gross collections.
2. Pull total billed. Same filter set but on submitted_at instead of paid_at. Per-practice sum = gross charged.
3. Compute collection % per practice. collected ÷ billed. Industry benchmark for behavioral health: 92-96% on commercial, lower on Medicaid. Anything <85% needs investigation.
4. A/R aging snapshot. Open A/R Aging tab — note the dollar amount in 90+ days. Compare to last month's snapshot (you should be screenshotting these monthly). If 90+ is growing AND collections are not, you have a collection problem, not a billing one.
5. Denial rate per practice. Denials tab, filter date range. denials ÷ total claims submitted per practice. >8% is high. Drill in: is it one payer, one CPT, one provider? That's your root cause.
6. Generate agency invoices. For each practice on a percent-of-collections deal: agency fee = gross_collected × fee_pct. Use Billing Services → Generate Invoice on each client to draft. Review, send.
7. Write the practice update. Per-client one-pager: this month's collections, comparison to last month, top denial reason, top action you took for them. This is what justifies your fee — most agencies skip it and that's why they churn.
8. Plan next month's focus. Pick ONE practice (the worst performer) and one improvement initiative for them (e.g. eligibility verification process change, payer contract negotiation). Calendar it.

Watch-outs

• Cash vs accrual. Collection % above uses cash receipts in the month. Claims billed last month but paid this month count toward THIS month's collected. That's fine as long as you're consistent — but if you compare your number to a practice's accrual-basis P&L, you'll fight about it. Pick one method and document it.
• Payer adjudication lag. A claim billed on the 28th won't have a payer response by month-end. Don't penalize practices for low collection % in their first month on the platform — give it 60 days.
• Refunds + recoupments. Payers occasionally claw back payments via ERA. Make sure you're netting recoupments against collections, not double-counting them as denials. The ERA importer handles this if you import every ERA; if you're entering manually it's easy to miss.
• The "growing A/R" trap. A growing A/R can mean (a) you're billing more so dollars in the pipe naturally grew, OR (b) collections are stuck. Don't conclude (b) without checking (a). Index A/R as days in A/R, not dollar amount, to control for volume changes.

Related jobs

• Bill the practice for your services — the actual invoice generation
• Work A/R aging — RCM Specialist playbook for what to DO about a growing A/R

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