SPF
SPF Revenue Cycle Solutions
STRATEGIZE. PRIORITIZE. FOCUS.
FREE RESOURCE / SELF-ASSESSMENT TOOL
Revenue Cycle
Audit Checklist
Is your billing leaving money on the table? Use this checklist to assess the health of your current revenue cycle — section by section.
YOUR SCORE
__
Fill in after completing
How to use this checklist: Work through each section and check every item that accurately describes your current practice. Count your total checked items at the end and refer to the scoring guide below. Items marked HIGH are the most critical to your revenue.
32–40
Strong
Your revenue cycle is performing well. Minor optimizations may still apply.
20–31
Needs Attention
Revenue leakage is likely. Several areas need focused improvement.
0–19
At Risk
Significant revenue is being left uncollected. Action is needed now.
1 / Eligibility & Verification
6 items
Eligibility is verified before every appointment
Not just at intake — verified at each visit, especially for recurring patients
HIGH
Deductible, copay, and coinsurance are confirmed per visit
Benefit details are checked and documented prior to service
HIGH
Out-of-network benefits are checked when applicable
OON reimbursement rates are confirmed before services are rendered
MED
Authorization requirements are identified at eligibility check
Auth requirements flagged and tracked before first appointment
HIGH
Patient financial responsibility is communicated before the visit
Patients know their expected out-of-pocket amount upfront
MED
Eligibility rejections or failed checks have a documented follow-up process
No patient slips through without a verified benefit on file
MED
2 / Claims & Billing
7 items
Claims are submitted within 48–72 hours of date of service
Delayed charge entry is one of the most common causes of revenue loss
HIGH
Claims are scrubbed before submission
A claim scrubbing process catches errors before they reach the payer
HIGH
CPT codes and modifiers are reviewed and updated annually
Outdated codes result in denials and underpayments
MED
Secondary claims are submitted promptly after primary EOB receipt
Secondary billing is not being missed or delayed
MED
Corrected claims are resubmitted within the payer's timely filing window
Corrected claims have a tracked resubmission deadline
HIGH
Clean claims rate is at or above 95%
Industry benchmark — below 95% indicates a systemic billing issue
HIGH
Timely filing deadlines are tracked per payer
Each payer's filing limit is documented and monitored
HIGH
3 / Payment Posting & Accounts Receivable
6 items
ERAs are reconciled within 24–48 hours of receipt
Payments are posted promptly and balanced to deposits
HIGH
Underpayments are identified and flagged during posting
Payer payments are compared to contracted rates at posting
MED
AR aging is reviewed at least monthly
Outstanding balances are categorized by age and payer
HIGH
Claims over 30 days unpaid have active follow-up
No claim sits without a status check past 30 days
HIGH
Patient balances are billed promptly after insurance adjudication
Patient statements go out within 1–2 billing cycles of EOB receipt
MED
Write-offs require documented approval before being applied
A write-off policy exists and is consistently followed
MED
4 / Denial Management
5 items
Every denial is reviewed and categorized by root cause
Denials are not simply re-billed without understanding why they failed
HIGH
Appeals are submitted for all clinically supported denials
Denial appeal rate is tracked and reviewed regularly
HIGH
Denial trends are reviewed monthly
Patterns by payer, code, or provider are identified and addressed
MED
Overall denial rate is below 5%
Industry benchmark — above 5% signals a process breakdown
HIGH
Prevention workflows are in place for top denial categories
Root causes are addressed upstream, not just worked after the fact
MED
5 / Credentialing & Enrollment
5 items
All active providers are enrolled with all payers they accept
No provider is billing a payer they are not contracted or enrolled with
HIGH
CAQH profiles are complete and attested within the last 120 days
Outdated CAQH profiles can delay or suspend credentialing
MED
Recredentialing timelines are tracked for all providers and payers
Recredentialing deadlines are on a calendar with advance reminders
MED
New providers are enrolled before they begin seeing patients
Enrollment applications are submitted well in advance of start date
HIGH
Payer demographic information is accurate and current
Address, billing NPI, and pay-to information is up to date with all payers
LOW
6 / Reporting & Visibility
5 items
Monthly collections reports are reviewed by practice leadership
Collections data is reviewed, not just filed away
MED
KPIs are tracked: clean claims rate, denial rate, days in AR, collection rate
Core metrics are measured and trended over time
MED
Revenue leakage has been identified and addressed in the last 12 months
A formal or informal revenue audit has been completed recently
MED
Billing staff or partner provides regular performance updates
You are not the one chasing down billing status — they bring it to you
MED
You know your current days in AR figure
Industry benchmark: under 30 days for behavioral health practices
HIGH
Not happy with your score?
Schedule a complimentary discovery call with SPF Revenue Cycle Solutions. We'll walk through your results and identify exactly where revenue is slipping through the cracks.