Navigating the world of healthcare billing can be a tumultuous ride. Below are six CentralReach billing features you can implement NOW to easily get your claims processed faster and more efficiently!


Client and Payor Setup.

Are your claim forms having the information you want in the boxes you want? This sounds easy, it’s information in a box, but setup helps ensure that your data is coming to you or your billing team as complete as possible. You can default client Diagnosis codes, boxes (and their digital equivalents) 17, 31, 32, 33, all within CentralReach. Pointers and modifiers can also populate the boxes for you as well!

If you are having incomplete data dropped to your billing entries, then that can create incomplete claims. Be an investigator: investigate the source(s) of the problem, and get that data backfilled. Each area of “drop in” in CR is mapped to a location. Go back to that place, and fill it in. Usually we tell clients, that with proper setup, within 2 batches or so, you can get almost all of the data setup to be trouble free, because dropping the data to claims should be the fastest part of the claims process.

Client and Payor setup


ERAs (Electronic Remittance Advice) are just digital versions of paper EOBs (Explanation of Benefits). Just, we know, right? They are amazing. Since an ERA is coded and standardized, just like an outgoing claim, having a system that can read the ERA data is amazingly fast and easy to use. Now, this does not mean that an insurance payor, paid you correctly, but it is a fantastic tool to post all the itemized payment data, to the itemized billing entries, and that is what claims are all about, itemized entries. The pain here for most companies is how to read and post this data quickly and accurately. In order to take advantage of ERAs, you must submit electronically via CR, and the ERA must come back to CR from the clearinghouse as well. Make sure that you take advantage of this, and if needed, sign up with your payors to use this service that they already offer (in most cases).


Secondary Claims.

Billing secondary is difficult, no matter how you slice it. Paper secondary claims can be made in CR easily, especially if all the payer info is set up for all payors that belong to a client. Some payers even offer secondary electronic claims– check your clearinghouse to see which one’s offer it. If so, CR is now able to send secondary claims electronically as well. The one thing you will need to ensure though, is that you are receiving the ERAs from the primary payer(s). The reason for this is so that CR can capture and transmit all of the ANSI coded payment information with the secondary claim(s).


When it comes time to invoice your clients, copay (patient responsibility), or self/private pay, as long as you have the data in all the right boxes it can be a snap. Using the filters on the billing screen you can select a large date set, then filter to only outstanding items (money to be collected!). This will pull all entries that show an amount owed, and leaves all zero owed amounts behind. Then you can generate up to 5000 lines of data to invoices at once. Also, if you know what copay is owed we are seeing more and more organizations billing copays right after they bill insurance.

Secondary Claims


What I mean by this is your billing cycle. Many people think that this is dictated by your employees converting their appointments. While that is still our number one complaint (yes, we wish we could make people convert as well), remember it is up to you to determine your billing timelines, and enforce them. There are tools in CR to have the system look at the schedule and find any unconverted appointments. So, admin team, set your dates and start contacting employees who have not converted. If you like to export data, then run the export, make a HIPAA compliant format from the data, and email out as needed.

Billing screen tools.

There are lots of ways to filter data, but you do not have to be limited by only the data you see on the screen. Remember you can use your contact labels, service code labels, billing entry labels, etc. Since these are all custom defined you can define your workflow to best suit your needs. Also, have you ever looked at and played with all the filters on the billing screen, there are many, check them out!

Billing Screen tools

Lastly, if you are having trouble billing and getting paid, check out our preferred vendors’ page. We also have a great recorded webinar walking you through CentralReach’s Billing module, for your viewing pleasure.

About the author: Adam Sellers is a CentralReach Billing and Practice Management subject matter expert working from Utah.

If you are a clinical entrepreneur familiar with an Accounts Receivables table, chances are you cringe when you scroll to the furthest right-hand column. This dreaded section, known as the “120 column”, is the “I hope I get paid”, “prayers needed” black hole of billing.

120+ Days Overdue
The best case scenario for claims housed in “120” is they are four months late. However, for many over-worked practice owners, out-standing claims are ancient, some due many years ago.

What Does “120” Really Mean?
As a clinical entrepreneur, “120” signals two potential scenarios: (1) you get paid hideously late (2) you don’t get paid at all. Unfortunately for a bank, they only see one column, the latter scenario, which is a red light for loan approvals.

How to Select an “Outsource” Partner
This brings us to an important point. “Outsourcing” implies a lack of transparency, and sadly some companies operate this way. If a billing company doesn’t share details about its workflows and practice, then run the other way. Think of it this way. If that company were to suddenly disappear, what would you do?

While every practice has owed payments on the books, only those due within the last 90 days are deemed financially “healthy.” Since banks like to see A/Rs frequently, you have to keep an eye on that right-hand beast. Therefore take a deep breath and select that “plus sign” in CentralReach (or other therapy billing application) to see those scary overdue claims details.

Drilling Down “The Black Hole”
Cutting away at the dead branches is imperative for any practice seeking funding. That’s why a healthy 120-column should look more sparse than a maple tree in Boston in mid-January. When you drill down to review the individual appointments that weren’t paid, you’ll find the biggest culprits boil down to the same reason:

  • Claim was rejected and needed reworking (i.e. no follow up)
  • Sent to wrong address or email (i.e. no follow up)
  • Missing additional information needed (i.e. no follow up)
  • Payment was supposedly sent but never received (i.e. no follow up)
  • Insert problem here – still, no follow up

Follow Up Wisely
While every therapy billing system is different, you’ll need to drill down by payer and client to tackle what’s needed. In CentralReach the copay is automatically separated from the claim amount, which makes pinpointing who to chase much easier.

Obviously dollar amounts vary for each line item, but chasing a $40 payment can be just as time-consuming as one for $9,0000. If you’re paying someone $20 an hour to chase late payments, they better be hunting large game and more importantly, focusing on your top payers. For example, if an insurance company owes you $100,000, and 25% of it ($25,000) resides in the “120” column, a bank may not count ANY of it if they mark the payer as unreliable.

Taming The Beast
While it’s daunting to drill down the Black Hole of Billing, it’s still your ticket to loan approvals and recouped money. Think of it like like an oil well. It may seem dark and gloomy, but your attitude will change quickly when you start seeing bling and cha-ching.

By Adam Sellers, Director of Implementation, and Christie Calahan, Director of Marketing and Communications

[quote ]The following post features advice from guest-blogger Emily Stowe, Managing Director of Bronco Billing, a CentralReach partner company.

If you are like most clinical entrepreneurs, you have probably encountered challenges with billing. Chances are, obstacles like claim rejections, late payments and ever-changing payer requirements can demand more of your energy than your most challenging client.

If this sounds familiar, you are not alone. Many great companies struggle with billing, especially in the therapy fields. Applied Behavior Analysis (ABA) billing is especially complicated as it is a relatively new area.  

Why Hire a Billing Company?
There are four main reasons practices seek external help:

  1. Growth and demand for services outpace the ability to upkeep back-office operations. This includes everything from billing and contracts, to managing staff.
  2. Experienced experts in ABA billing practices are rare and hard to find.
  3. An organization wants to feel more in control of their finances. Depending upon who handles your billing, an expert can equip you with knowledge to make better decisions.
  4. Some prefer having an expert and partner vested in your organization’s success.

Why Keep Billing In-House?
If you have great management and workflows, it could be more cost-effective to keep at least a portion of your billing in house.

How to Select an “Outsource” Partner
This brings us to an important point. “Outsourcing” implies a lack of transparency, and sadly some companies operate this way. If a billing company doesn’t share details about its workflows and practice, then run the other way. Think of it this way. If that company were to suddenly disappear, what would you do?

Signs of a Good Partner
If you’re looking to hire a billing company, there are some traits you should require:

  • Transparency and training in the workflows surrounding your company
  • Experience in successfully navigating the ever-changing market
  • An understanding of your company’s goals
  • A vested interest in your success
  • A willingness and expectation to be supportive in all aspects of your organization, not just billing.

How Much Help Is Needed?
Every practice is unique, so it’s important to consider what kind of help you need. For example, Bronco offers three different service models.

  1. Premier Billing – all-inclusive, white-glove service
  2. A La Carte Services – for specific needs including:
  • Handling a portion of payers
  • Creating, training or managing in-house employees
  • Contracting, credentialing, verifications, etc.
  • Unpaid claim management & other issues
  1. Consulting Services – which encompasses topics such as:
  • Maximization of authorizations
  • Workflow optimization
  • Billing standardization
  • Employee retention planning
  • Cash flow increase (e.g. how to bill more time, etc.)
  • Profit analysis

Is Your Practice Financially Healthy?
Regardless of your billing arrangements, every entrepreneur should know their C.R.A.P.!

  1. Cash flow
  2. Receivables
  3. Analysis of Payers
  4. Practice Management Workflows

Once you nail these basics, you can start to make improvements.

For a closer look at healthy billing practices, join our interactive webinar on September 25th.
Co-Authored by Emily Stowe, and Christie Calahan, CentralReach’s Director of Marketing and Communication.

Tracking authorizations to determine if you’re over-billing or under-utilizing staff can be time consuming and difficult if you’re using multiple systems. CentralReach makes it simple. We integrate scheduling, authorizations, billing, and productivity into one.

How can your system help my schedulers track authorizations and organize staff productivity?

Using CentrlReach authorizations, schedulers have the ability to quickly analyze staff productivity and client utilization. They can view each client’s authorization to compare hours authorized against those scheduled and/or worked. Think about how much time you could save with data at your fingertips to ensure clients are receiving the appropriate amount of treatment hours, rather than digging through multiple schedules or timesheets.


Also, administrative staff can review caseloads for each of their supervisors to compare performance and ensure each of them is meeting company standards. Staff who are not can be identified quickly for further training.

How do I maximize hours authorized using CentralReach?

First, our automated system reduces errors commonly found with manual authorizations tracking processes. You can eliminate hours of tedious work and simply get the numbers on paper, quickly review them and make determinations about whether or not additional staffing is needed or current staff are being over-scheduled.  Next, CentralReach allows you to maximize authorizations, which means you can utilize as many hours as possible with your given staff.  This is beneficial for two important reasons.

  • Providing the full amount of hours authorized means your clients are receiving the amount of treatment recommended to best meet their needs. This is good for overall care for the client and best business practices for you.
  • Maximizing authorizations means maximizing revenue as you provide the best possible care for each client. Tracking authorizations using our system will help you identify areas at risk for overbilling and prevent it.

How does all of this help me prevent overbilling?

Rather than bringing up each schedule weekly, schedulers can look at our authorizations module to organize employee calendars and assess which clients are under-scheduled. Any client with a red negative number has authorization hours remaining.  Knowing which clients have hours left is one way schedulers can prevent overbilling.


From within our scheduling module, staff will receive warnings if they attempt to schedule employees with more hours than authorized for a client. This tool is money because it saves time by reducing the need for your staff to use multiple systems to confirm authorized hours for clients. They simply track authorizations using the module and go about scheduling. Our system will do the rest, giving clear alerts when there is potential to overbill.

And to help prevent overbilling even more, we have a global authorizations module that allows management to drill-down and compare authorizations at the payor level. This tool gives you quick access to current utilization totals, along with a recommended amount of hours, dollars and units per month or week. Schedulers typically use this information to maximize remaining authorizations. Because our system takes the guesswork out of the process, schedulers know what they need to do to prevent overbilling and they get it done fast. The key to proper authorizations management is up-to-the-minute data that lets you assess your practice and make adjustments to ensure a streamlined operation. You can manage authorizations and a whole lot more with our practice management solutions.