Every claim that comes back rejected, denied, or adjusted represents work that could have been avoided. That work costs time, delays cash, and sometimes ends in a write-off. Most business offices handle these problems one claim at a time. A monthly review that steps back and looks at patterns can reduce how many occur in the first place.
Here is a practical checklist you can adapt to your building or your portfolio.
Before the meeting: gather the basics
Pull a short set of numbers for the month and compare with the previous few months.
- Number and dollar value of claims denied or rejected
- Claims resubmitted, and how many required more than one resubmission
- Write-offs and adjustments by category
- Payments received compared with billed amounts, by payer group
You are not looking for perfection. You are looking for movement and for concentration.
Checklist item 1: Are denials concentrated?
Break denials down by payer, by reason, and by the staff area where the issue began. Denials usually fall into a few categories, such as missing authorization, eligibility or coverage issues, incomplete documentation, or timing problems. If one category accounts for most of the volume, that is where to focus.
Checklist item 2: Where in the process did the problem begin?
A denial shows up at the end of the process, but the cause often began at the start. Trace a sample back.
- Was insurance information verified at admission?
- Was authorization requested and tracked?
- Was documentation complete and timely?
- Was the claim submitted promptly?
This turns a billing problem into a process question that involves admissions, clinical, and business office teams together.
Checklist item 3: How much rework are we doing?
Rework is the quiet cost in billing. Count how many claims are touched more than once and how many staff hours that represents. Even a rough estimate helps leaders understand the scale. A reduction in rework often frees up time that can go to collecting older balances.
Checklist item 4: What are we writing off, and why?
Write-offs should be understood, not just recorded. Sort them by reason:
- Contractual adjustments that are expected
- Timely filing or process failures that point to a fixable issue
- Uncollectible balances that reflect eligibility, payer, or resident circumstances
- Small-balance clean-up
Separating expected from avoidable write-offs lets you focus on the part you can influence.
Checklist item 5: Are appeals worth the effort?
For denied claims, track how many are appealed, how many are overturned, and how long it takes. Over time, you learn which denial types are worth pursuing and which are not. This helps allocate effort sensibly.
Checklist item 6: What is our first-pass payment rate?
The share of claims paid correctly the first time is a strong indicator of overall billing health. If it improves, you will likely see fewer denials, less rework, and faster cash. If it slips, something upstream has changed.
Checklist item 7: What are we changing this month?
Finish the meeting by naming a small number of actions.
- One upstream fix, such as a verification step at admission
- One payer-specific follow-up
- One training or communication item for a team
- One data question to examine next month
Assign an owner and a date to each.
A hypothetical example
Imagine a hypothetical building where a review shows that most denials in a given month are tied to missing authorization for a particular type of plan. The team creates a short checklist for admissions, adds an authorization status field to the weekly census meeting, and tracks the denial count for that payer next month. The review turned a recurring annoyance into a specific, measurable fix.
Pitfalls to avoid
- Treating every denial as a billing error. Many begin elsewhere.
- Skipping the review in busy months. Those are often when problems build.
- Reviewing too many numbers. A short list is easier to act on.
- Forgetting to close the loop. Check whether last month's fix worked.
Share the results
Short summaries help other departments see how their work affects the revenue cycle. Admissions, nursing, and therapy all play a role, and seeing results builds a shared sense of responsibility.
CarePulse Analytics can pull denial, rework, and write-off data into a monthly review view. If you would like to see how this looks with your own billing numbers, a demo is a good place to start.