Quick Stats
RCM Checklist
With admin tasks, insurance changes, and accounting, managing
all the necessary items for your practice can be overwhelming.
Completing the "RCM Checklist" tasks below will help you identify
things that need to be improved!
Scheduler
Are you using an electronic scheduler to track patients?
Are you tracking the patient’s appointment status and checking for
cancelations, no-shows, and rescheduled appointments?
Are you searching for all completed patient appointments without
charges/claims associated?
Are you analyzing reasons for canceled appointments? Is it because
Trusted RCM
of the practice, the therapist, or client?
Are you investigating patient eligibility trends?
partners of
Are you tracking how often your clinical staff saw a patient without
800
Prior Authorization.
PROVIDERS
Verification of Benefits – Check for active/inactive statuses for the
new year.
Is prior authorization required
Is the practice “In Network” or “Out of Network” with the
appropriate insurance carrier?
Are you reviewing procedures with staff regarding patient
referrals & authorizations for the new year?
Are you reviewing procedures with staff regarding patient
benefits, eligibility, deductibles, copays, and coinsurance
amounts for the new year?
RCM Checklist
01
BILLING
Are all claims out of the door in under three days?
Are all eligible payor claims being submitted electronically?
Are you ensuring that all the payors accept submitted claims?
Are you regularly reviewing billing guidelines for each state, plan, and
type of ABA service?
> 4.1 MN
Are you investigating patient eligibility trends?
Are you tracking how often your clinical staff saw a patient without
Prior Authorization secured before offering a service to the patient?
NUMBER OF Are you searching for all missing ERA's/EOBs?
SUCCESSFUL Are you ensuring that all ERA's/EOBs have been posted/
allocated/reconciled?
TRANSACTIONS
Are you tracking the relevant CMS guidelines?
Are you updated with all the new billing guidelines of 2023 for each
payor?
Are you aware of the critical claim denial trends you faced in 2022?
What are your plans to tackle them? (Coding denial trends, Denials
related to documentation, denials caused by incorrect credentialing,
coverage denials)
Have you updated practice fees, units/encounter forms, new client
intake forms, letters, etc., for the new year?
Coding
Are you tracking for recent codes/coding changes?
Have you checked for CPT codes – new/discontinued CPTs?
> 1.5 BN $
Are all the latest updates in your billing system?
Have you reviewed CPT and ICD-10 changes with your billing staff?
Have you reviewed coding guidelines related to each state, plan, and
VALUE OF type of service provided?
SUCCESSFUL Correspondence
TRANSACTIONS
Have you ensured that all correspondence is worked on time?
Are you tracking your mail/clearinghouse daily for new
RCM Checklist
correspondence?
02
Session/SOAP/Procedure Notes
Are there open and incomplete SOAP, Session, or Procedure Notes
that need to be completed?
Does the clinical documentation support the POS or Modifiers?
Are the billed time units validated with the actual Session 'In and Out'
times?
900+
AR Follow Up
rcm
specialists
(AAPC &
AHIMA
CERTIFIED
CODERS)
Payment Posting
Are you utilizing electronic payment posting for all eligible payors?
Are all payments posted into your system within 48 hours of receipt?
Are you validating if balances are applied appropriately?
Have you reconciled your remittances back to the deposits in your
bank account?
60
Client Responsibility
rcm
FOCUSED
BOTS
RCM Checklist
03
Payor Contract
Are you tracking insurance contracts for updated rates/rules/
modifiers and verifying the appropriate credentialing status for each
provider with each payor and in each state?
Have you obtained updated fee schedules from contracted Payors?
Do you check and update your Fee schedule?
Do you know when you are up for contract renewal with each payor?
Other important points
NATIONWIDE
COVERAGE
80 CLIENTS IN
25+ STATES
RCM Checklist
Schedule Free Assessment with RCM Experts
04
Schedule A Free RCM Assessment
Schedule A Free Year End Assessment
Contact us: [Link]
or call (469) 242-6053
RCM Checklist
05
