Free Lead Magnet · EP174–177 Series

The same Payment Posting Audit we run on guesswork 80+ medical practices — yours to use this week.

The same 14-point payment posting audit we run across 80+ medical practices. Print it, hand it to your biller, and you'll know within a day whether your posting is solid or silently leaking revenue.

Get the Free Checklist See what's inside

Built by physicians. Used across 80+ practices #2 globally on Feedspot's RCM podcast list

Companion to the Series

The Payment Posting Series — Episodes 174 through 177

Why payment posting is the foundation of your financial truth — and the four episodes breaking down exactly how we audit it.

Why this matters

Bad posting silently breaks good practices.

It hides denials. Fakes your aging. Turns month-end into a fire drill. After 80+ audits, the same four patterns show up again and again.

01 — Hidden Drift

Dump account postings

Payments parked in suspense or "miscellaneous" buckets instead of being applied to the correct claim. Quietly costs six figures a year.

02 — Lying AR

Adjustment-code misuse

CO-45, PR-1, and OA-23 mean very different things. When they get used interchangeably, your AR report stops reflecting reality.

03 — Lost Denials

Insurance-side mistakes

Denials posted as adjustments instead of being worked. Take-backs that never get tracked. Variances that never get flagged.

04 — Fire Drill Close

Reconciliation drift

When deposits don't match remits and nobody catches it on day one, month-end becomes a forensic project instead of a close.

What's inside the checklist

14 audit checkpoints. Run it this week.

The exact framework our team uses when we start a payment-posting audit. Print it, hand it to your biller, and you'll know within a day whether your posting is solid or quietly leaking revenue.

Audit Checklist · PDF

Payment Posting Audit Checklist

14 checkpoints across 4 categories — used on 80+ practices.

Daily deposit-to-remit reconciliation
Suspense / dump account audit
Adjustment code accuracy review
ERA-to-EOB matching workflow
Posting timeliness benchmark (48-hour rule)
Variance flag protocol
Patient responsibility transfer accuracy
Denial-as-adjustment red flag scan
Take-back / recoupment tracking
Refund and credit balance triggers
Secondary claim auto-trigger check
Month-end close reconciliation steps
AR-aging cross-validation
Posting role and accountability map

Category 01

Reconciliation

The daily and monthly checks that catch mismatches between what was deposited, what was remitted, and what was actually applied to claims. This is where most posting errors first show up — and where most teams stop looking too soon.

Use this if: month-end close routinely takes more than three business days.

Category 02

Adjustment Integrity

Every CARC and RARC tells a story. When your posters use the wrong code — or worse, default to a generic adjustment — your AR report turns into fiction and your denial team loses its workload.

Use this if: your denial percentage looks suspiciously low.

Category 03

Variance & Take-Backs

Underpayments, overpayments, and recoupments that get posted but never flagged. Each one is a denial in disguise — and most practices have no system to surface them.

Use this if: nobody on your team can quickly tell you last month's variance dollars.

Category 04

Process & Accountability

The roles, the rules, and the timing. Who posts. When they post. What gets escalated. Without this layer, even the best technical checklist falls apart inside three months.

Use this if: nobody on your team owns posting end-to-end.

Why us

A physician built this — because she lived the problem.

Dr. Heather Signorelli

Founder, NatRevMD
Practicing Physician & RCM Operator

"We built this checklist because we've seen what happens when posting goes unchecked — and we've seen what changes when it doesn't."

0 Practices served

0 Globally · Feedspot RCM

0 Podcast episodes

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Drop your details below — we'll send the PDF straight to your inbox, then you can book a free 15-minute audit call with Heather.

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Common questions

Before you download — here's what to know.

Yes, genuinely free. We use this checklist internally on every practice we audit, and we publish it because we want practice owners to know whether their posting is solid — whether or not they ever talk to us. After you download, you'll get the PDF and one short follow-up note offering a 15-minute review. That's it. No drip campaign, no sales calls.

Most billing audits stay surface-level — coding, claim submission, denial rates. This one goes one layer deeper, into the part of the revenue cycle that's most often overlooked: payment posting. It's the layer where errors compound silently and where most "lying AR reports" originate. The framework is what we use across 80+ practices, not a generic template pulled from the internet.

Not at all. The checklist is yours regardless. Many practices run it with their existing in-house biller and never need anything else from us — and that's a great outcome. If after running it you find you'd like a fresh set of physician-led eyes on a few specific risk areas, the optional 15-minute call is there. No obligation either way.

About 90 minutes for a focused first pass with a sample of 20 recent remits. A few days if you want to run every checkpoint exhaustively across all four categories. Most practice owners find that even a partial run flags one or two clear issues worth fixing immediately.

Frame it as a tool, not a test. Good billers welcome a structured framework — it gives them language to surface what they already suspect is happening but haven't been able to articulate. The checklist is structured so the conversation focuses on systems and process, not blame. In our experience, billers usually find it useful within the first 15 minutes.