Billing & RCM

The Revenue Cycle worklist

A/R aging, every claim's status, and the work items that are the only place anything actually gets done.

7 min · Billing & RCM, Administrators · lesson v1

The top-level Billing tab is one screen: Revenue Cycle. It is deliberately small — an aging strip, a list of claims, and a queue of things that need a human.

The aging strip

  1. Four tiles across the top: A/R 0–30 days, A/R 31–60 days, A/R 61–90 days, A/R 90+ days. Each shows a dollar total and a claim count.

    They count every claim that is not PAID — so a denial, a draft nobody submitted, and a partially paid claim all age together.

    Screenshot pending capture

That last point is worth sitting with. The aging strip is not "money the payer owes"; it is money that has not arrived, whatever the reason. A large 90+ tile is as likely to be claims that were never sent as claims a payer is sitting on.

The claims list

Claims (n) has five columns: Claim, Status, Payer, Total, Age (shown as 42d).

The statuses you will see:

StatusMeaning
DRAFTCreated but not scrubbed or sent
SCRUBBEDChecked and ready to go
SUBMITTEDWith the clearinghouse / payer
PARTIALLY PAIDSome money arrived; a balance remains
PAIDSettled — drops out of aging
DENIEDPayer refused it
NEEDS REWORKFlagged for correction

Empty, it tells you where claims come from: No claims yet. Finalize billing on an encounter to create one. Claims are born when a clinician signs off and attests codes.

The work items

  1. Open work items (n) is the actual queue. Each carries a priority chip and a type:

    • Denial rework
    • A/R follow-up
    • Patient balance
    • Eligibility issue

    Row buttons: Start, Open, Resolve, Escalate.

    Screenshot pending capture

Opening one gives you a workspace with ← Back to worklist, a HIGH PRIORITY chip where it applies, and a Next step: line telling you what this type of item needs. The primary button changes to match:

Item typeButtonWhat it's asking
Denial reworkRework & resubmit claimReview the payer denial, correct the claim, and resubmit it to the clearinghouse.
A/R follow-upResubmit claimFollow up on the aged claim — resubmit it so the payer payment can post.
Patient balanceOpen patient billingPost the patient responsibility and queue a statement from the patient's Billing tab.
Eligibility issueOpen patient billingRe-check the patient's coverage and benefits from the patient's Billing tab.

Escalate and Mark resolved close the loop. Resolve when the money has posted or the balance is genuinely settled — not when you have finished typing.

What this screen does not do

Being clear about the edges saves you hunting:

  • No claim filters or search
  • No submit / correct / write-off / post-payment buttons on a claim
  • No ERA or remittance posting — there is no file upload and no auto-post. Remittance data is shown read-only inside a work item, and patient payments are posted by hand on the patient's Billing tab

What usually goes wrong

Working the claims list. It is a report. Work the queue.

Resolving on resubmit. The item exists until payment posts.

Reading aging as payer delay. Check whether the old claims were ever actually submitted.

Looking for a way to post an ERA. There isn't one yet. Payments go on the patient's Billing tab, one at a time.

Check yourself

No score, no account — just make sure you can answer these before you move on.

  1. A claim is sitting at DENIED. What do you do to it from the claims list?

    Show the answer

    Nothing — the claims list is read-only. Every action lives on the Open work items side: a denial produces a Denial rework item with a Rework & resubmit claim button. If a denied claim has no work item, nobody is working it, and that is the thing to notice.

  2. What do the A/R aging tiles count?

    Show the answer

    Every claim whose status is not PAID, bucketed by age — A/R 0–30 days, 31–60, 61–90, 90+. So a denied claim, a draft that was never submitted and a partially paid one all sit in the aging just the same. Ageing money is ageing money regardless of why.

  3. You press Rework & resubmit claim and it says Claim resubmitted to the clearinghouse (synthetic). Is the work item done?

    Show the answer

    No. The message ends Mark this resolved once payment posts. Resubmitting is a step; the item stays open until the money arrives, which is the whole point of a worklist.