The billing census leak checklist

Before you start

• Pick a completed month. Not the current one. Incomplete weeks look like hundreds of errors and they are not.
• Pull three things: the facility attendance logs, the billing census for the same period, and access to the clinical record.
• Write down your thresholds before you look at anything. IOP and PHP minimum hours, and what your intake day policy actually is.

Check 1 · Unbilled attendance

Was work delivered that nobody ever billed?

• Count attendance marks in the facility logs for the month.
• Count billed service entries in the census for the same period.
• Reconcile the two totals. Write the gap here: ______

There is no denial and no report for a claim you never submitted. This one is invisible unless you go looking.

Check 2 · Billing above documentation

Is anything billed that the chart cannot support?

• Pull twenty billed lines at random from the month.
• Trace each one to a signed note. Count that resist: ______
• If more than one or two resist, treat it as a process gap between census and chart, not a documentation problem.

The rule that prevents it: when in doubt, hold the entry rather than bill it. An unbilled documented day can be billed late. A wrongly billed day becomes a clawback.

Check 3 · Threshold days

Which days fell under the level-of-care line?

• Sort the month's census by hours. Read the bottom of the list.
• Flag every IOP day under 3 hours and every PHP day under 5. Count: ______
• Now read the names, not the numbers. Note any client appearing more than twice.

Repeat short days are not a billing problem. That is an engagement conversation for the site director, and it is worth more than the claim.

Check 4 · Level-of-care conflicts

Did any care level change outrun its authorization?

• List every client whose level of care changed during the month.
• For each, confirm the effective date matches in the facility log, the census, and the clinical record.
• Confirm an authorization covers the new level from that date. Count that do not: ______

This is the check that most often finds real money on the first pass.

Check 5 · Identity mismatches

Thirty seconds, and the highest return item on this page.

• Open your facility attendance log template.
• Look for a medical record number column. Is there one?   Yes ☐   No ☐
• Check whether any service posted for a client discharged in a prior month.

If there is no MR number column, your team links services to billing episodes from memory every week. Adding that one column closes the entire class of error, permanently, for free.