Case study · A/R reconciliation

The system said $234,000 was collectible.

A practice asked us to audit one payer’s claims because collections felt slower than the reports suggested. Roughly 4,400 claims across seventeen months. The reports were not lying. They were counting the wrong things.

What we were asked to do.

Nobody thought there was a collections problem. Cash was arriving. The aging report looked ordinary. The owner’s question was narrower than that: why does the balance sheet say one thing and the bank say another.

We took one payer, pulled every claim for seventeen months, and reconciled the book line by line against posted cash. Not a sample. Every claim.

Engagement

Scope

One payer, approximately 4,400 claims, seventeen months of dates of service.

Basis

Agreed rates, by code and date of service. Never billed rates.

Output

A reconciled A/R balance, a quantified write-off, and a ranked fix list.

Table 1 — what the reconciliation found
A/R reconciliation — one payer, ~4,400 claimsCompleted engagement
System showed collectible233,729
Adjustments and voids restored11,455
Claims priced wrong in the system(25,966)
Cash received, never posted to claims(70,766)
Overpayments reclassed to liability10,149
Uncollectible, quantified(18,603)
True A/R$139,998
Basis: agreed rates (RateClientAgreed), by code and date of service · figures from a completed engagement, anonymized

Reading the lines.

Cash received, never posted — $70,766

Money that had cleared the bank and was never applied to the claims it paid. Those claims still showed open. This was the single largest error and the reason the aging report looked worse than reality while cash looked better than the ledger.

Claims priced wrong — $25,966

The rate loaded in the practice management system did not match the agreed rate on the contract. Every claim at those codes was carrying a receivable that was never going to arrive in full. No report flags this, because each claim looks paid correctly against its own loaded rate.

Adjustments and voids restored — $11,455

Sales adjustments voided in error. Real revenue that had been written off the book by a keystroke. Traced and reversed.

Uncollectible, quantified — $18,603

Past timely filing. This is a write-off, not a receivable. Leaving it in A/R does not make it collectible, it just makes every forecast built on A/R wrong.

Overpayments reclassed — $10,149

Payer credit balances sitting in revenue. Recoupment was coming. It belongs in liabilities, not on the income statement.

What was left — $139,998

Of the true balance, about $14,000 was still inside the filing window and worth chasing immediately. Another $43,000 needed the payer to status it claim by claim before anyone could call it collectible or write it off.

Three root causes. None of them collections.

Every dollar of the $93,731 overstatement traced back to configuration or process inside the practice management system. Rates loaded wrong. Cash not applied. Adjustments voided by mistake.

Nobody was chasing the wrong payer. They were chasing the wrong number. A collections push against a $234,000 target would have burned staff hours against $94,000 that did not exist, and left the actual causes in place to do it again next quarter.

This is why the books and the revenue cycle have to sit with the same team. An accountant who does not touch the claims cannot tell you the rate table is wrong. A biller who does not hold the ledger cannot tell you the cash was never applied.

Worth being precise

This was a claims audit. It reconciles the back half of the revenue cycle, claim by claim, to cash.

The Leak Map starts three stages earlier — at the reservoir of hours a family has actually agreed to, the sessions that get cancelled and never come back, and the lag between a delivered session and a submitted claim.

Different instruments, different depth. Either one puts a verified number under the practice.

See the Leak Map

Start with the numbers.

Book a 20-minute fit call

Twenty minutes to find out whether this is a fit. Not a strategy session, and we will not have your numbers yet.