Start with the billing and practice-management reports
Define the reports that show charges, contractual adjustments, patient payments, payer payments, refunds and outstanding accounts receivable. The exact reports vary by platform, so document the source and reporting period used each month.
Match collections to bank activity
Compare reported payments with deposits received. Timing differences, deposit batching and merchant-processing fees can create legitimate differences, but they should be explained rather than left unresolved.
Connect deposits to the general ledger
Verify that deposits, fees, refunds and adjustments are recorded consistently in the accounting system. This creates a clear trail from operational reporting to the financial statements.
Review accounts receivable movement
Beginning A/R, new activity, payments, adjustments and ending A/R should form a coherent bridge. Large or unexplained movements deserve follow-up with the billing team.
Document exceptions and ownership
A useful reconciliation identifies the difference, its cause, the person responsible for follow-up and the expected resolution date. Repeated exceptions often reveal a workflow or system issue.
Revenue reconciliation does not replace medical billing. It provides financial oversight around the information produced by the billing process. The final scope should reflect the practice’s systems, available reports and division of responsibilities.
Illustrative collection-to-deposit bridge
| Item | Amount |
|---|---|
| Payments reported in the billing source | $100,000 |
| Less receipts not deposited by cutoff | ($6,000) |
| Add prior-period receipts deposited now | $4,000 |
| Less processing fees withheld | ($2,000) |
| Expected matching bank deposits | $96,000 |
Original teaching example only, not client data or a benchmark. $100,000 − $6,000 + $4,000 − $2,000 = $96,000.
For this illustration, the starting payments report is gross of the listed processing fees; the listed adjustments are distinct and do not overlap. Actual treatment depends on source-report definitions. Do not deduct fees or refunds twice if the starting report is already net of them.
Cutoff means the end of the reporting period being compared. Receipts not deposited by cutoff belong to the starting receipts population but have not reached the bank. Prior-period receipts deposited now were outside that starting population but reached the bank during this period.
If actual matching deposits differ from the expected total, investigate the cause rather than posting an unexplained balancing entry. This bridge matches cash receipts to deposits; it does not establish accounting revenue recognition, and it does not imply billed charges equal deposits.