Your real week

Imagine you are eight months in. You have two clients: a two-provider family practice and a solo physical therapist. Together they generate enough work for roughly half your week, which is what two clients should be. Here is the week.

Monday: intake and entry

The practices send Friday's superbills, plus stragglers from the weekend portal. You start with eligibility checks on new patients, then charge entry: matching each superbill line to the right patient account, catching the obvious problems before they become claims. The therapist's office has a new billing person who codes a knee session as a shoulder again, so you send back a note. Thirty seconds of correction beats a denial cycle that costs three weeks. Monday afternoon you scrub and batch-submit everything clean. Claims leave by four.

Tuesday: the rejection queue

Overnight the clearinghouse returned its reports. Fourteen claims rejected: a handful of transposed Medicare numbers, two policies termed, one rendering NPI wrong on a new provider. Each one takes two to ten minutes to fix and resubmit. This is the least glamorous and most profitable two hours of your week, because rejected claims cost the practice nothing but delay if you catch them, and delay into silence if you do not.

Wednesday: posting and statements

Remittances arrive. You post the ERAs, watch the payments land against accounts, and flag the denials into Thursday's pile. Then patient statements go out: the deductibles and coinsurance balances Medicare and the commercial payers left behind. Between tasks, three patients call about their statements. One is angry about a bill for a service they thought was free. You explain the deductible calmly, because you are the only person in this arrangement who both understands the explanation and is not seeing patients all day. That call is part of the product.

Thursday: denials and follow-up

The hard day. You work the denial stack from Wednesday's postings: read the reason codes, pull the documentation, write the corrected claims and the first-level appeal letters. Then you run the aging report and start calling on claims sitting past thirty days, because payers do not pay attention to claims that sit, and standard practice is to query any claim that reaches sixty days without payment. Hold music, a reference number, a promise to "reprocess within fifteen business days." Some of those promises are real.

Friday: the money report and the practice's week

You close the books for reporting: charges submitted, payments posted, denial rate, how much is sitting in old receivables. You send each practice a short summary and flag anything that needs a decision, like a payer that changed its policy on a code the family practice bills forty times a week. Friday afternoon is also when you do your own business work: invoicing your percentage, following your own pipeline, and, in the early months, doing outreach for client number three, which gets its own treatment later in this course.

When it goes wrong

Some weeks a payer "updates their system" and rejects two hundred claims for a formatting reason nobody announced. Some weeks the Medicare fee schedule change you missed in January means you under-billed a code for a month. Some weeks a client's front desk entered every patient under the wrong insurance for three days. The real skill is not avoiding these weeks. It is triaging them without letting the routine work slide, and telling the practice early. Bad news ages badly in this business, a theme the course returns to later.

The machinery that makes you worth a percentage, the follow-up and appeals work, comes later in this course.