A one-page self-audit to find where your revenue cycle is leaking. Built for practice owners, office managers, billing managers and billing companies. It takes about 15 minutes and you don't need any patient data to complete it.
Inside:
- 43 yes/no checks across front end, claims, denials, A/R, payment posting, reporting, staffing and HIPAA
- A KPI worksheet with consistent definitions
- A simple staffing cost comparison worksheet
Get the checklist
How to use it
Answer each item Yes, No or Not sure. Every "No" or "Not sure" is a place to look first. This is a self-assessment, not an audit or legal review.
1. Front end: scheduling, eligibility and authorizations
- ☐ We verify eligibility and benefits before every visit, not just for new patients.
- ☐ We re-check insurance cards and demographics at every visit.
- ☐ We identify coordination of benefits (which plan is primary) before the visit.
- ☐ We maintain a current prior authorization matrix by payer and service.
- ☐ We track authorization expirations and visit limits.
- ☐ We give the front desk an estimated patient responsibility to collect at check-in.
- ☐ We identify behavioral health carve-outs during eligibility checks (if applicable).
2. Charges and claims
- ☐ Charges are entered within 1-2 business days of the date of service.
- ☐ Claims are scrubbed before submission.
- ☐ Clearinghouse and payer rejections are worked daily.
- ☐ We track timely filing limits for each major payer.
- ☐ Coding is done or reviewed by credentialed coders for our specialty.
- ☐ We updated our systems for this year's code changes (ICD-10-CM changes Oct 1; CPT/HCPCS changes Jan 1, plus quarterly updates).
3. Denials
- ☐ Every denial lands in one queue with a named owner.
- ☐ Denials are categorized by payer and reason.
- ☐ Denials are worked at least weekly, by deadline and dollar value.
- ☐ Appeals are tracked with deadlines and outcomes.
- ☐ Top preventable denial reasons are reviewed monthly and fed back to the front desk and coders.
4. Accounts receivable
- ☐ We calculate days in A/R the same way every month.
- ☐ We review A/R by aging bucket and by payer monthly.
- ☐ A/R follow-up is prioritized by dollar value and age, not alphabetically.
- ☐ Every touched claim has a documented action and next follow-up date.
- ☐ We have a written write-off policy with approval levels.
- ☐ Patient A/R has its own workflow (statements, reminders, payment plans).
5. Payment posting
- ☐ ERAs are posted daily and reconciled to bank deposits.
- ☐ Zero-pay and partial-pay lines are flagged as denials.
- ☐ We compare payments to contracted rates to catch underpayments.
- ☐ Secondary claims go out promptly after primary payment.
- ☐ Credit balances are reviewed and resolved regularly.
6. Reporting
- ☐ Leadership sees a monthly KPI report (see worksheet below).
- ☐ We can see each staff member's queue and output.
- ☐ We know our top 5 payers by A/R and by denials.
7. Staffing and coverage
- ☐ More than one person can do each critical billing task.
- ☐ Billing staff have protected time (they aren't constantly pulled to the front desk).
- ☐ Procedures for each queue are documented.
- ☐ We have a plan for vacations, leave and turnover.
- ☐ We've compared our fully loaded in-house cost with other options (see worksheet).
8. HIPAA safeguards for vendors and remote staff
- ☐ Every vendor or agency with PHI access has a signed BAA.
- ☐ Every user has a unique login with multi-factor authentication.
- ☐ Remote access uses a VPN or virtual desktop; local downloads are blocked.
- ☐ Access is role-based and removed the same day someone leaves.
- ☐ Our HIPAA risk analysis includes remote and offshore access.
- ☐ Vendors must notify us of incidents within a defined timeframe.
See the HIPAA guide for outsourced billing staff for the full question list.
KPI worksheet
| KPI | Definition | This month | Last month | 3 months ago |
|---|---|---|---|---|
| Days in A/R | Total A/R ÷ (charges for last 90 days ÷ 90) | |||
| A/R over 90 days (%) | A/R aged 91+ days ÷ total A/R | |||
| Denial rate | Denied claims ÷ claims submitted | |||
| Clean claim rate | Claims accepted on first submission ÷ claims submitted | |||
| Net collection rate | Payments ÷ (charges − contractual adjustments) | |||
| First-pass resolution | Claims paid/resolved on first submission ÷ claims submitted | |||
| Charge lag (days) | Average days from date of service to charge entry |
Benchmarks vary by specialty and source; track your trend. Definitions are explained in our RCM staffing guide.
Staffing cost worksheet
| Line | In-house (per FTE) | Billing company | Remote staff (per FTE) |
|---|---|---|---|
| Base cost | Wage × hours | Fee × monthly collections | Quoted rate |
| Benefits & taxes | (BLS: benefits ≈ 30% of private-industry compensation costs, June 2026) | Included | Included in rate (confirm) |
| Recruiting/training | |||
| Software seats | |||
| Equipment/remote access | |||
| Management time | |||
| Monthly total |
Source for the benefits share: BLS Employer Costs for Employee Compensation.
Scoring
- 0-5 "No/Not sure": solid foundation; focus on fine-tuning.
- 6-15: specific gaps; pick the section with the most "No" answers and fix it first.
- 16+: the revenue cycle likely needs more structure or capacity. Consider a free staffing assessment.
(Scoring bands are a simple rule of thumb, not a validated benchmark.)
Technology
When you run this audit, check which steps are already automated (eligibility checks, claim scrubbing, claim status) and which still depend on manual work. Large RCM vendors are moving payer-policy checks to the front end so requirements are visible before care is delivered (Fierce Healthcare). Alliance Global Solutions helps clients set up AI assistant workflows alongside their dedicated staff.