90-Day Revenue Cycle Recovery Checklist

The 90-Day Revenue Cycle Recovery Checklist is a sequential protocol for independent practices with denial rates above 8%, days in AR above 40, or net collection rates below 93%. Actions are ordered by expected revenue impact — the highest-leverage interventions first — rather than by ease of implementation. The protocol is designed for a billing manager or practice administrator to execute without outside consulting engagement.

Days 1–30 (immediate triage): pull a 90-day denial report sorted by CARC code frequency and dollar volume; identify the top three denial codes by dollar — these drive the recovery. Run an AR aging report; identify all claims 90–120 days old with no follow-up activity. Establish a claim status check workflow for all claims at 30 days with no payment or denial. Verify eligibility for all new and returning patients at time of scheduling.

Days 31–60 (systematic correction): appeal all identified soft denials (CO-96, CO-97, CO-50, CO-16 with documentation) with regulatory-cited letters. Audit prior authorization workflow for the top five procedures generating CO-15 or CO-4 denials. Pull a clean claim rate report; identify front-end edits causing the largest volume of rejections. Implement a 60-day claim follow-up tickler for all outstanding claims.

Days 61–90 (structural fixes): renegotiate or clarify any payer contract terms contributing to CO-45 (contractual adjustment) discrepancies. Implement denial tracking by payer and code. Benchmark resulting metrics against MGMA targets to quantify recovery. A well-executed 90-day protocol typically recovers 60–80% of addressable revenue leakage within the period.

• Denial Risk Tool — score your metrics before starting
• RCM benchmarks — target figures for the recovery protocol
• Cash Leakage Calculator — quantify the dollar impact