Best Practices to Oversee Your Billing and Collections

A Practical Framework for Real-World Oversight 

Your revenue cycle isn’t just a back-office function, it’s the financial backbone of your organization. Yet many practices still rely on high-level snapshots like monthly charges and deposits to evaluate billing performance. That reactive approach often leaves revenue issues undetected until they’ve grown too large to ignore. 

Oversight doesn’t require complicated analytics or expensive software. It starts with monitoring a handful of accessible metrics that give you real-time insight into where your money is moving—and where it’s stalling. Whether you’re a provider, administrator, or billing leader, these five weekly checkpoints will give you the clarity you need to take action before small issues become major problems.  

Here are five key metrics that should be reviewed weekly to gain insight into how your revenue cycle is really functioning: 

1️⃣ Total charges vs. payments posted 

2️⃣ Deposit and posting variance 

3️⃣ Adjustment activity review 

4️⃣ A/R movement and variance 

5️⃣ Front desk performance and collections 

You may already be tracking some or all of these metrics, but how you track them matters just as much as whether you do. Using the wrong reports, overly generalized categories, or inconsistent timeframes can lead to misleading conclusions and missed opportunities. These metrics are only valuable when they’re evaluated with clarity, consistency, and a focus on root cause. 

Let’s break each one down and discuss what it tells you, and why it matters. 

1️⃣ Total Charges vs. Payments Posted

■ This metric offers an essential comparison of the work your practice is doing (charges) against what you’re being paid for (payments). Reviewing this weekly helps identify mismatches that could indicate claim holds, payer slowdowns, or workflow gaps.  

■ By reviewing by date of service, we can assess the financial performance and payment trends of services delivered during a specific time period. This view helps isolate where revenue is delayed or missing entirely, and over time, it also reveals the average percentage of charges your practice is actually collecting. This is critical for setting realistic cash flow expectations and spotting payer or process inconsistencies.   

■ By reviewing by posting date, we can monitor when payments are actually hitting your system, which helps flag slowdowns in payer processing or internal posting backlogs. This perspective complements the date of service view by reflecting actual revenue movement. 

■ In addition, reviewing both views may reveal patterns around specific services, CPT combinations, or modifiers that consistently lead to payment delays due to additional payer review. Recognizing these trends helps your billing team proactively refine workflows, educate providers on documentation standards, and avoid repeated rework on the same types of claims, ultimately supporting a cleaner, faster reimbursement process. 

2️⃣ Monitor for Deposit and Posting Variance

■ If you aren’t actively reviewing a report that compares what was deposited daily to what was posted daily, chances are this reconciliation process isn’t being done. And when it isn’t, it becomes far too easy to miss payment posting errors, overlooked deposits, or worse—revenue leakage and misconduct. Reconciliation ensures every EFT, mailed check, and in-office payment, regardless of the number of deposits generated per day, is accurately balanced and appropriately reflected in your system. 

■ Not balancing daily means your organization is not truly accounting for all the monies received in a day’s time. And if there’s no regular monitoring to ensure that reconciliation is occurring, then it likely isn’t. This isn’t just a gap in process, it’s a risk to your organization. Without weekly oversight of this daily process, there’s no way to verify that deposits are being handled correctly, that payments are being recorded accurately, or that all revenue is making its way into your system. This opens the door to operational problems, delayed revenue, and potential integrity concerns that could enable inappropriate behavior involving both cash and non-cash payments. 

3️⃣  Adjustment Activity Review

■ Adjustments are literally writing off work your practice has performed, either as reduced reimbursement or as completely non-reimbursable. Yet surprisingly, they’re often one of the least monitored metrics in the revenue cycle. In many practices, the billing team uses a single write-off code labeled “Insurance Adjustment” across the board, regardless of the reason for the adjustment. This broad categorization creates a serious reporting blind spot, preventing oversight into where and why revenue is being lost, and reducing accountability across teams. 

■ To properly monitor adjustments, practices must move beyond a single write-off code. Every adjustment should be tied to a specific, non-contractual reason code that accurately reflects why it occurred. Having this level of distinction allows for true oversight and reporting capabilities based on the cause of revenue loss, whether it’s a timely filing issue, a medical necessity denial, a professional courtesy write-off, or an out-of-network service. This categorization supports more accurate financial reporting, easier audit trails, and actionable performance insights.  

■ When this isn’t in place, not only is your data inaccurate, it’s also nearly impossible to audit. Reviewing adjustment activity weekly allows for a proactive response to patterns of avoidable revenue loss, flag internal posting inconsistencies, and ensures you’re not routinely writing off dollars that could have been recovered with better documentation or follow-up. 

■ If your weekly reports don’t provide a breakdown of adjustments, or if nearly every adjustment falls under a general label, it’s a clear sign your billing process needs restructuring. 

4️⃣  Monitoring Variance in A/R

■ Accounts Receivable (A/R) is where your revenue sits until it’s collected or written off, and too often, practices track the total but not the trend. Monitoring weekly variance in A/R helps you understand whether outstanding balances are increasing, decreasing, or stagnating. But it’s important to recognize that there is no universal “ideal” A/R number. Chasing a target A/R value without understanding what’s behind it can lead to harmful practices, such as inappropriate or premature write-offs just to reduce the reported total. Instead, focus on trends and variances that reflect your actual operational performance. This oversight is key to evaluating the effectiveness of your collection efforts, including both insurance follow-up and patient responsibility. 

■ By reviewing A/R movement by payer, age, and provider, you can catch early signs of delays, identify gaps in follow-up workflows, and ensure high-balance accounts aren’t being ignored. Many organizations wait until A/R has reached critical levels before they invest in a billing audit, provisional resourcing, additional staffing, or PM system improvements. By then, the issue has already affected cash flow, and efforts to course-correct often become reactive. Monitoring weekly prevents you from playing Friday night quarterback, trying to explain an exponential rise that could have been addressed weeks earlier. If your A/R is growing without explanation, or shrinking due to write-offs instead of true collections, it’s a clear sign to investigate both your process and your follow-up performance. 

5️⃣  Front Desk Collection Totals (Copays, Balances)

■ The revenue cycle begins long before a claim is submitted; it starts the moment patient information is entered into your system. That’s why your front desk team plays a critical role in both the financial and operational success of the practice. Yet, front desk performance is rarely analyzed as part of the RCM strategy.  

■ Monitoring what’s collected at the point of service, copays, deductibles, and balances, is one of the most immediate and impactful ways to reduce A/R and support cash flow. Patients are most likely to pay when they’re in the office, and front desk staff should be empowered to collect with clear expectations and support from their providers. Physicians should reinforce these efforts by backing up financial policies with their patients. 

■ But collections are just one part of the picture. Repeated errors in demographic or insurance data entry result in claim denials that the billing team cannot control, creating rework, delays, and revenue leakage. Weekly monitoring helps leadership assess not only what’s being collected, but also how consistently front-end processes are being executed.  

■ If collection totals are low or vary significantly by day, location, or staff member, that may indicate unclear policies, insufficient training, or system limitations. By performing continuous analysis of front desk performance, you can identify training needs, address gaps in processes, and reinforce that the front desk is not separate from RCM, it is the starting line. 

■ Don’t assume point-of-service collections and accurate data capture are happening just because a policy exists. Monitor the data, and act on what it tells you. 

Why This Matters 

Too many practices evaluate their billing based on how the bank account feels. But if you wait for revenue trends to show up in your deposits, you’re already weeks behind the problem. 

Instead, these weekly metrics offer a more timely, tactical look into what’s really happening in your revenue cycle. They’re accessible, actionable, and essential to creating financial stability.  

So, the question becomes: What are you monitoring—and how often? 

If you’re relying on month-end reports or broad overviews, it’s time to dig deeper. The goal is not just to collect revenue, it’s to manage it, measure it, and make it predictable.

Contact Us
Download Checklist