By Lemuel Areglo, CPC | Director of Revenue Cycle Management Services
Key Takeaways
- Unresolved denials, infrequent A/R reviews, and aging patient balances can quietly undermine your practice’s financial stability. By the time these issues become apparent, your cash flow may already be compromised.
- Many denials can be avoided with proactive measures. Gaps in eligibility, coding mistakes, and incomplete information can all be addressed before claims are submitted, provided you have effective verification and scrubbing processes in place.
- Patients who are informed of their financial responsibilities upfront tend to pay more promptly and are less likely to dispute charges. Unexpected bills often lead to dissatisfaction and delayed payments.
- Revenue cycle issues do not arise suddenly. They develop gradually, and by the time they are recognized, your cash flow may have already taken a hit.
This guide addresses the most frequent reasons for stalled collections and offers actionable workflows to resolve them. Focus on the section that is currently most pressing for your practice — each is designed to be independently useful.
Table of Contents
Why Collections Are Challenged
The simple truth: ownership of the entire process is often unclear.
The front desk assumes that billing will handle eligibility issues, while billing relies on complete clinical documentation. This lack of clarity can lead to claims falling through the cracks, resulting in unpleasant surprises when the A/R report reveals concerning trends.
Speech therapy practices face unique challenges. SpeechTherapy billing differs significantly from other specialties like orthopedic or cardiology billing. A billing team that manages multiple specialties may lack the specialized knowledge needed to identify errors specific to speech therapy before claims are submitted, leading to compounded issues.
Common issues include:
- Eligibility gaps — If insurance is not verified prior to the appointment, claims may be sent to the wrong payer or denied altogether, resulting in delays.
- Documentation deficiencies — Inadequate clinical notes that fail to justify the services rendered can lead to payer rejections.
- Coding errors — Incorrect CPT or ICD-10 codes can result in underpayment or denial. Specialty coding requires expertise that generalist billers may not possess.
- Lack of follow-up process — Claims can age without follow-up, leading to missed timely filing deadlines and unrecoverable losses.
Establishing a Denial Prevention Framework
Denial prevention should be viewed as a systematic approach rather than a reactive cleanup task.
Preventing Denials Before Submission
Most denials are avoidable. The primary reasons — missing information, eligibility issues, and coding errors — can all be identified before claims are submitted.
Ensure insurance eligibility is verified prior to each appointment, not just at check-in. Confirm the payer, plan type, copay, deductible status, and any prior authorization requirements, and document this information thoroughly.
Utilize claim scrubbing before submission. Your billing software should identify missing modifiers, bundling issues, and frequency limit violations. If it doesn’t, you risk sending out claims that are likely to be denied.
Identifying Denials Promptly
When a denial is received, it should be routed for review the same day. Every hour it remains unaddressed brings you closer to missing the timely filing deadline. Categorize denials by reason code — eligibility, authorization, coding, documentation, or duplicate — and track patterns. If one provider has a higher denial rate, it may indicate a documentation issue. If a specific payer denies more frequently, it could signal a contract problem.
Resolving Denials Within 48 Hours
Aim to resolve denials within 48 hours of receipt. If a denial cannot be resolved at the first level, escalate it promptly and ensure it does not remain unresolved. Document the resolution steps for each type of denial to avoid reinventing the process each time.
Effective A/R Follow-Up Strategies
The reality is that reviewing A/R monthly is insufficient; it is merely documentation. Genuine follow-up should occur weekly, prioritizing claims based on age and dollar amount.
Collection probabilities decrease significantly as claims age. Claims under 30 days have a collection rate above 95%, while those over 120 days may drop below 50%. Each week of inaction moves you further down this curve.
A straightforward weekly routine:
- Day 1 — Review claims aged 0–30 days. Confirm receipt and ensure claims are being processed.
- Day 2 — Address claims aged 31–60 days. Contact payers for any claims with no activity and document every interaction.
- Day 3 — Escalate claims aged 61–90 days, as they are nearing critical age.
- Day 4 — Take aggressive action on claims over 90 days. Check for timely filing deadlines to prevent losses.
- Day 5 — Follow up on patient balances and initiate conversations about payment plans.
KPIs to track:
Metric
Target
Days in A/R
Under 35
A/R over 90 days
Under 15% of total
Clean claim rate
95%+
Denial rate
Under 5%
Identifying Barriers to Claims Processing
Inefficiencies in billing often stem from either role confusion or intake errors.
When one individual manages registration, eligibility, charge entry, and follow-up, accountability diminishes. It is crucial to separate front-end tasks (registration, eligibility, authorization) from back-end tasks (coding, billing, A/R). This distinction is important even in smaller practices.
Another significant issue is poor data collection at intake. Incorrect insurance IDs, demographic errors, and missing authorization numbers can lead to claims failing later in the process, often when the visit is already weeks old and documentation is less reliable.
Advanced EHR vendors provide AI-powered intake platforms that enhance intake accuracy and alleviate front desk bottlenecks, ultimately reducing the incidence of data errors that can delay claims processing.
Verify information before the appointment:
- Patient demographics
- Active insurance coverage and effective dates
- Copay, deductible, and coinsurance status
- Prior authorization (if required)
- Estimated patient responsibility communicated to the patient
Submit claims daily instead of in weekly batches. Daily submissions allow errors to be identified while the encounter is still fresh, and they also catch clearinghouse rejections early — a rejected claim won’t even enter the payer’s queue.
Collecting Patient Payments
With the rise of high-deductible plans, patient financial responsibility has increased significantly. Collecting these amounts requires a different approach compared to collecting from payers.
The key factor is not just the design of your statements but the conversations you have with patients before their visits. Patients who understand their financial obligations beforehand are more likely to pay promptly and have fewer complaints. Conversely, those who receive unexpected bills are less likely to pay and may not return for future services.
Collect copays at check-in. Send statements within a week of claim adjudication. Provide convenient payment options, such as online payments, phone payments, text-to-pay, and payment plans for larger balances. Patients who have multiple payment options are more likely to utilize them.
A basic outreach schedule:
- Statement sent on day 0 (post-adjudication)
- Reminder sent on day 30 (statement + email or text)
- Phone call made on day 45
- Final notice sent on day 60 with a payment plan offer
- Consider collections at day 90
Document every attempt. A thorough paper trail is essential if an account eventually goes to collections.
Quick-Reference Checklists
Pre-visit
- Demographics verified
- Eligibility confirmed
- Benefits documented
- Authorization obtained (if required)
- Patient informed of estimated costs
Claim submission
- All fields completed
- Diagnosis codes support medical necessity
- Procedure codes match documentation
- Modifiers applied correctly
- Claim scrubbed
Denial management
- Denial identified within 24 hours
- Reason code categorized
- Resolution initiated within 48 hours
- Appeal filed (if applicable)
- Root cause logged for pattern tracking
Patient collections
- Copay collected at time of service
- Statement sent within 7 days of adjudication
- 30-day reminder sent
- 45-day phone outreach attempted
- Payment plan offered before day 60
The Integration Challenge Many Practices Overlook
A significant portion of billing inefficiency arises from handoff issues rather than personnel problems. When clinical documentation, practice management, and billing operate in separate systems, data must be re-entered, leading to errors and missed charges.
SpeechTherapy-Cloud integrates all three functions into a single platform. When a provider completes an encounter, billing processes begin immediately with complete clinical context — no exports, no manual entry, and no gaps. For practices seeking to enhance their operations, SpeechTherapy-Cloud Billing Services provides dedicated specialists who understand your specialty, adhere to a weekly A/R cadence, and identify denial patterns before they escalate into revenue issues.
If your in-house billing team is struggling with high volumes, increasing denial rates, or staff turnover that disrupts continuity, it may be time to consider outsourcing as a more viable solution.
The workflows outlined above are effective. The key question is whether your current setup can support them. If it cannot, it may be worth reevaluating your approach.
Talk to our billing team for a FREE billing analysis.
Lemuel Areglo, CPC
is the Director of Revenue Cycle Management Services at WRS Health, bringing nearly 15 years of experience leading medical billing, coding, credentialing, and revenue cycle operations across the healthcare industry. Lemuel’s expertise spans the full revenue cycle, including claims management, denial resolution, payment posting, accounts receivable, and practice operations. He has extensive experience supporting specialties including speech therapy, psychiatry, physical therapy, pain management, internal medicine, and sleep medicine.
