Why It’s Important to Do an End-of-Year Review in RCM

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6 min read

As another year winds down, most practices are focused on closing out their books, meeting year-end goals, and preparing for the upcoming CPT and fee schedule changes. But before the ball drops, there’s one task that can have a bigger impact on next year’s revenue than any other: a thorough end-of-year RCM review.

A year-end review isn’t just a financial checklist—it’s an opportunity to evaluate the overall health of your billing operations, identify hidden risks, and position your practice for a smoother, more profitable year ahead. It’s the RCM equivalent of an annual physical: diagnose what’s working, treat what’s not, and strengthen your systems for long-term performance.

Here’s a guide to what that process should include and why each step matters.

1. Check the Health of Your Account

Start by asking the big question: How healthy is your revenue cycle?
An end-of-year review should begin with an honest look at the current state of your account and workflows.

Unlocked or Unbilled Charts

These are the low-hanging fruit of lost revenue. Unlocked or unbilled charts can delay claim submission and create preventable write-offs. Review your encounter logs or billing queues to ensure all charts are locked, coded, and billed before year-end. Even a small backlog can add up—especially if those claims cross into a new timely filing period.

ICD-10 and CPT Updates

Each year brings updates that can directly impact billing accuracy and reimbursement.

  • ICD-10 updates go into effect every October 1, introducing new diagnosis codes and retiring old ones. If your EHR or billing system hasn’t been updated—or if staff haven’t been trained—coding errors can spike in Q4.

  • CPT code updates, effective January 1, require similar attention. Review your most-used procedure codes, especially for high-volume services, to ensure accurate mapping in your charge capture tools.

It’s also smart to verify that payers have updated their systems accordingly. Early in the year, mismatches between payer edits and provider coding updates can trigger denials.

2. Review Your Fee Schedule

Your fee schedule is more than a list of numbers—it’s the foundation of your reimbursement strategy. Yet, many practices overlook it until something breaks.

Start by asking:

  • Are there any changes that need to be made to the current fee schedule?

  • Is there a term date that needs to be extended?

  • Are you adding a new fee schedule for the new year due to payer contract updates or rate changes?

Annual payer fee schedule adjustments can have a huge impact on profitability. Compare your current charges to both Medicare’s Physician Fee Schedule and your top commercial payer contracts. If you’re undercharging relative to market benchmarks, you’re leaving money on the table.

And don’t forget to verify that your fee schedule updates are actually loaded correctly in your billing software. A single outdated rate can cause months of inaccurate billing downstream.

3. Credentialing: Avoid Disruptions Before They Happen

Credentialing often flies under the radar—until it doesn’t. Nothing creates chaos faster than discovering a provider’s contract has lapsed or a revalidation was missed.

During your end-of-year review:

  • Check if any contracts are set to terminate within the next few months.

  • Confirm whether any revalidations are due soon.

  • Review your payer rosters to ensure new providers have been fully credentialed and linked to group contracts.

This is also the perfect time to evaluate your credentialing process itself. Is it proactive or reactive? Consider setting automated reminders or using credentialing software that flags upcoming expirations before they turn into revenue interruptions.

4. Conduct a Deep AR Review

Accounts receivable (AR) can reveal more about your RCM health than almost any other metric. A clean AR balance means you’re collecting efficiently; a messy one can signal process breakdowns.

Let’s break down the essentials:

Open Insurance Claims Over One Year

Claims older than a year are often uncollectable due to timely filing limits. Review your aging reports and identify claims that need to be adjusted off. This step doesn’t just tidy your books—it gives you a more accurate picture of true outstanding revenue.

Zero-Balance Claims

Claims that have been fully processed and paid should be closed out. Keeping them open clutters your AR and can skew reports. Clean data leads to better decision-making and more accurate KPIs.

Patient Balances

Patient AR requires its own careful review:

  • Small balance adjustments: Determine if you have policies for writing off minimal amounts that aren’t worth the collection cost.

  • Bad debt vs. collections: Evaluate which accounts should be transferred to collections versus written off as bad debt.

  • Deceased patient balances: Ensure there’s a defined process for handling these ethically and accurately.

  • “Do Not Send Statement” lists: Verify these accounts are correctly flagged and that staff are following established workflows.

If your team doesn’t have a documented process for any of the above, now’s the time to create one. Consistency reduces risk and ensures compliance across your revenue cycle.

5. Review Key Performance Indicators (KPIs)

Your KPIs tell the story of your year—both the wins and the opportunities. This is where the review shifts from looking backward to planning forward.

Some key metrics to analyze:

  • Days in AR: Are you trending higher or lower than this time last year?

  • First-pass claim acceptance rate: Has automation or scrubbing improved accuracy?

  • Net collection rate: How much of your collectible revenue are you actually receiving?

  • Denial rate: Which denial reasons spiked this year—and why?

Once you’ve reviewed the data, take it a step further:
Where did we start the year vs. where are we ending?
What did we do well, and what needs improvement?

This reflective step is often skipped but is invaluable for growth. Use it to identify what strategies worked—like better front-end verification or improved denial management—and where bottlenecks still exist.

Then, set goals for next year. Break them into quarterly milestones so progress feels achievable and measurable. For example:

  • Q1: Reduce AR over 90 days by 10%

  • Q2: Increase clean claim rate to 95%

  • Q3: Complete recredentialing for all providers due in 2026

  • Q4: Implement an updated fee schedule audit process

Quarterly goals keep momentum steady and make it easier to celebrate small wins along the way.

6. Clean Up Processes—and Celebrate Progress

An end-of-year review isn’t only about identifying problems. It’s also a chance to celebrate what went right. Maybe your denial rate dropped, your cash flow improved, or your team reduced average claim lag days by half. Recognizing those improvements builds morale and reinforces what’s working.

At the same time, use the review as a springboard for process improvement.
Ask:

  • Are there workflows that can be automated next year?

  • Do staff roles need to be redefined or cross-trained?

  • Are internal audits catching issues early enough?

Small operational tweaks—like better documentation templates, new clearinghouse edits, or refined AR follow-up rules—can yield big efficiency gains over time.

7. Prepare for a Fresh Start

Once the analysis is complete, it’s time to close the loop. Document your findings, summarize your key metrics, and create an action plan for the new year. This should include:

  • A list of updates to implement (fee schedules, code sets, credentialing deadlines)

  • KPIs to track quarterly

  • Process improvements to pilot

  • Any staffing, training, or technology needs identified

Consider holding a brief “year-in-review” meeting with your RCM or billing team to share highlights, lessons learned, and next year’s focus areas. This not only keeps everyone aligned—it reinforces a culture of accountability and continuous improvement.

The Big Picture: Why It Matters

In RCM, small issues left unchecked tend to compound. A few unlocked charts become hundreds of delayed claims. A missed revalidation leads to denied payments. Outdated fee schedules quietly erode margins.

That’s why a structured end-of-year review isn’t optional—it’s essential. It ensures you start January 1st with a clean slate, a clear plan, and confidence in your data.

Think of it as preventive maintenance for your financial engine. The more proactive your approach, the fewer surprises you’ll encounter when payer updates hit, claim rules change, or volumes fluctuate.

By investing time in your year-end review, you’re not just closing out 2025—you’re setting up a stronger, more resilient RCM operation for 2026.

Final Thoughts

The most successful practices treat the end of the year not as a finish line, but as a launch pad. A thorough review gives you the insight to correct course, sharpen performance, and enter the new year with momentum.

Because in revenue cycle management, what you don’t know will cost you—but what you review, measure, and improve can transform your bottom line.

So, pour the coffee, pull the reports, and take that hard look under the hood.
Your future self—and your next year’s revenue—will thank you.

Stay proactive, stay profitable, and make every claim count.
Contact Triumph Medical Practice Solutions at 214-305-8805 to start your new year with confidence and clarity.