January is hard on practices that coast through the fourth quarter. Timely filing windows close on claims nobody worked. Payers change their rates, but the system still expects last year's numbers. A payer contract renews on old terms because no one tracked the notice date. Each problem is cheap to fix now and expensive to fix later.
This checklist covers the year-end work that protects next year's revenue, and who should own each item. If you are still deciding whether your revenue cycle has deeper problems, start with the five warning signs your revenue cycle needs an audit. This post assumes you are ready to act.
1. Work old claims before filing windows close
Every payer sets its own filing limit, and the clock starts on the date of service. MGMA's revenue cycle guide is blunt: a late claim is very unlikely to be paid, and payers and state insurance commissioners will back that denial. Missing the appeal window is also the most common reason a denial is upheld.
Build or update a timely filing matrix from your participation agreements, and share it with front office and billing staff.
Pull accounts receivable (A/R) by payer and date of service. Flag every open claim approaching its filing or appeal deadline.
Work the list highest dollar first, as MGMA's model open-claims policy does.
Confirm the payer received each claim, and keep proof of timely filing.
Watch for clusters of open claims from one submission date. MGMA's policy treats that as a possible failed batch and calls for resubmission within 24 hours.
2. Clear credit balances and refunds
Credit balances are money the practice does not own. Clear them before year-end. MGMA's model credits policy sets a workable standard:
Flag credits at payment posting and route them to one person or team.
Apply credits to the guarantor's open balances where policy allows. Refund the rest.
Require supervisor approval before any refund is issued.
Notify patients in writing about credits that have not been refunded or applied.
Research returned and uncashed refund checks. The model escheat policy sets a 120-day research window, and unresolved credits after 12 months move to state unclaimed-property reporting.
The model policy gives government payers priority because federal refund timelines apply. Escheat rules vary by state. Confirm your obligations with counsel.
3. Review write-offs and adjustments
Separate what the contract required from what the practice lost.
Report a full year of non-contractual adjustments by reason, payer and employee.
Confirm each non-contractual write-off has documented collection efforts and supervisor approval.
Check staff write-off authority. MGMA's model policy requires the limit in writing and caps it at $100 unless the Administrator or a designee approves more.
Update the adjustment code dictionary. The model policy calls for a quarterly review.
Confirm small-balance write-offs followed policy. MGMA's model threshold is $9.99, for patient balances older than 120 days with nothing pending from insurance.
Each timely filing or missing-authorization write-off is a process failure. Carry the top reasons into next year's training plan.
4. Run a full-year denial review
A full-year view shows which problems the practice tolerated all year. Group denials by payer, procedure code, provider and reason, then rank them by dollars.
Use a benchmark for context. In MGMA's 2024 Operations Management Edition, the revenue cycle chapter recommends a denial rate of no more than 2% to 3% of claims and a clean claim rate above 95%. The author notes they will vary by practice.
Watch for signs of payer change, such as a new prior-authorization denial on a procedure that never needed one. Every top reason should leave the review with an owner, a fix and a date.
5. Load next year's fee schedules and check contracted rates
MGMA's model fee schedule policy analyzes fees on or about November 1, with changes effective January 1. The same review compares actual payer reimbursement with expected reimbursement, so the practice can decide which contracts to renegotiate.
Pull your 25 to 50 most frequently billed codes, as MGMA's revenue cycle guide suggests, and compare your charge with each payer's allowed amount.
Treat any code paid at 100% of your charge as a sign the fee is too low. Payers normally pay the lesser of your charge or their allowable.
Treat codes paid at half of your charge as a prompt to review the fee or the contract.
Load each payer's new rates before January claims go out, so underpayments flag automatically.
Tell providers that a fee increase will raise A/R. MGMA's policy notes this should not be read as poor billing performance.
6. Confirm contract renewal and notice dates
Most payer contracts are evergreen. They continue until someone acts. In MGMA's Operations Management Edition, payer contracting author Doral Jacobsen cites an August 2023 MGMA Stat poll in which 58% of medical groups said they review payer contracts annually. The chapter also warns that a missed renewal window can leave a practice on its current terms for another year.
Build a contract calendar this quarter:
List every payer agreement with its effective date, term, renewal date and termination notice requirement.
Flag automatic renewals. Gordon and Tolliver note they can become a bargaining point in rate negotiations.
Check for pending amendments. Many are deemed accepted if the practice does not respond within the stated timeframe.
Contract terms are legally binding. Have counsel review notice and termination language before acting.
7. Review the charge master, charges and coding updates
The charge description master (CDM) holds every practice charge by procedure code. MGMA's revenue cycle guide recommends reviewing the master fee schedule at least once a year. Do it before the first January claim.
CPT and HCPCS codes are updated annually. Have a certified coder compare the CDM, superbills and EHR templates with the new code set, retire deleted codes and price new ones.
Confirm that diagnosis code (ICD-10-CM) updates are loaded in the EHR and practice management system.
Do not hard-code modifiers into the CDM unless they apply every time. MGMA's guide warns that usage rules change by payer and by edits.
Pull a charge audit sample now. MGMA's model policy calls for monthly random audits of charge accuracy and quarterly coding-update training for providers and billing staff.
8. Get the front end ready for January
Many plans renew in January, and patients arrive with new cards and reset deductibles. Before the holidays, confirm your eligibility tool runs in batch, refresh the financial policy, and schedule front-desk training. A later post covers this in depth.
9. Close the year cleanly
MGMA's model closing policy treats year-end as month-end plus annual reporting and tax preparation. Its key controls:
Post all charges and receipts, then reconcile the practice management system to the general ledger.
Reconcile bank accounts, accounts payable and A/R within three business days of month-end.
Advance the system date only after reconciliations are confirmed, so no entries land in a closed period.
Keep accounts payable open no more than two weeks after year-end to capture late invoices.
Issue preliminary financial statements by the third week of January.
What to do this quarter
Billing manager, now: build the timely filing matrix and work every claim near its deadline, highest dollars first.
Practice administrator, by November 1: complete the fee schedule analysis, the contracted-rate comparison and the contract calendar.
Billing manager, November: clear credit balances, review write-off authority and adjustment codes, and finish the full-year denial review.
Coder and billing manager, early December: load new codes, fees and payer rates, then test a sample of claims.
Front office manager, December: train staff on the updated financial policy and the January verification workflow.
Practice administrator and accountant, January: close the year and issue preliminary statements by the third week.
The bottom line
Year-end revenue cycle work is invisible until it is missed. Practices that clean the books, load next year's rates and lock down contract dates start January collecting. Practices that skip it spend the first quarter fixing last year.
Ark Advisory Group helps independent practices run this year-end review, with an owner and a deadline for every item. Learn about our healthcare practice consulting, start with our free Operational Health Self-Assessment, or book a discovery call at (908) 900-4607.
Sources: Kem Tolliver and Shawntea Moheiser, Revenue Cycle Management: Don't Get Lost in the Financial Maze (MGMA, 2020); Taya Gordon and Kem Tolliver, Advanced Strategy for Medical Practice Leaders: Financial Management Edition (MGMA, 2023); MGMA, Advanced Strategy for Medical Practice Leaders: Operations Management Edition (2024); MGMA, Operating Policies and Procedures Manual for Medical Practices, 6th ed. (2025). Model policies are illustrations to adapt, not requirements. This article is general guidance, not legal, tax or compliance advice.
