A 20-Min Spot Audit to Uncover Hidden Intake Risk
A 20-Min Spot Audit to Uncover Hidden Intake Risk
Most front-end mistakes don’t get flagged until claims go unpaid. This audit helps you catch them upstream—without needing IT or new software.
Eligibility gaps, auth missteps, and mismatched visit reasons don’t always show up in dashboards. But they show up in write-offs, frustrated billers, and front desk staff “doing their best.”
This 20-minute spot audit is designed for operators who want a sharper view—fast.
Step 1: Pull 5 High-Risk Visits From Last Week
Start with completed appointments that involved imaging, minor procedures, or complex payers (e.g. Medicaid MCOs, commercial with specialty carve-outs).
For each, gather:
- Appointment and visit type details
- Eligibility verification timestamp
- Auth status (if required)
- CPTs billed and claim status (denied, paid, pending)
If you’re short on time, just focus on one day and scan for patterns.
Step 2: Look for These Common Misses
1. Eligibility Was Verified—Too Early
Many schedulers run eligibility at booking (weeks out) and never recheck. That’s how you get CO-27/CO-29 denials—even when eligibility was technically “done.”
Check:
- Was eligibility re-verified within 48 hours of the visit?
- Any signs that walk-ins or reschedules skipped verification altogether?
2. Auth Was Requested—But Not Approved or Aligned
Don’t just check if auth exists. Check if it matches the actual CPTs billed. We often see cases where auth was for “consult” but the visit included procedures.
Check:
- Was the auth valid for the billed service line?
- Was it approved before the date of service?
3. Visit Reason ≠ Services Rendered
Was the appointment scheduled as “follow-up” but turned into a full workup? Did documentation support a higher-level code, but front desk never flagged the change?
Check:
- Was the scheduled visit type appropriate for the work performed?
- Did the visit require a modifier (-25, -59) due to unexpected complexity?
Step 3: Tally the Risk
If 2 out of 5 visits show issues, that’s a 40% intake leakage rate. Multiply that by the number of similar visits per month—and the missed revenue adds up fast.
Keep this exercise lightweight. The goal is to surface blind spots, not create a report for finance.
Bonus: For Advanced Teams
If you already have reporting tools, take it further.
1. Crosswalk Denials With Intake Data
- Export 90 days of CO-197, CO-29, and CO-50 denials
- Tag them by location, scheduler, and service line
- Identify clusters—often a single staff member or specialty drives outsized risk
2. Monitor Timing of Eligibility Checks
- What % of eligibility verifications are run after 5 PM the day before the visit?
- Late batch jobs often fail silently, and the visit proceeds anyway
3. Check for “Drift” Between Scheduled and Delivered Modality
- Was the visit scheduled as in-person but conducted via phone or portal?
- Modality drift causes billing mismatches that show up as rejections—not errors
Try It With Your Team
Have your front desk lead pick 3–5 visits and walk through them side-by-side. You’ll uncover silent assumptions, outdated SOPs, and process gaps that aren’t visible on reports.
This kind of peer audit builds awareness—and leads to better handoffs.
Want Help Tracing It Further?
At BettyWell, we help clinics run fast, focused front-to-back audits that trace denials to intake breakdowns, without spinning up long projects.
Book a 20-minute Ops & Revenue Review and we’ll walk through your top 2–3 front-end risk points—live—and leave you with a fix-it plan.