Revenue leakage: twelve places money goes missing before it is ever billed

A denial is at least a signal. Leakage is silent: nothing is rejected because nothing was ever submitted, or because the underpayment matched no rule that would flag it.

The twelve

1. Unbilled encounters — a visit happened, no charge exists. Reconcile the schedule against the charge file, every day.
2. Missing procedure charges on a billed visit — the E/M went out, the in-office procedure did not.
3. Supplies, devices and drugs administered but not captured, where separately payable.
4. Hospital and ASC rounding or consults never entered.
5. Under-levelled E/M where the documentation supported more — the mirror image of the over-coding risk everyone watches.
6. Contractual underpayment — paid, but below the contracted rate. Undetectable without loaded fee schedules.
7. Unworked denials past appeal deadline — recoverable revenue that expired in a queue.
8. Timely filing lapses on claims that never made it out of a rejection queue.
9. Patient balances never pursued after the third statement, with no policy defining what happens next.
10. Credit balances and unapplied cash sitting unreconciled — a compliance exposure as well as a distortion of your A/R.
11. Uncollected co-pays at time of service, which cost far more to chase later.
12. Unmanaged write-offs without an approval threshold or a monthly review by reason code.

How to run it

Pick three lines. Quantify them for a single month using your own data. Assign each to an owner with a monthly control — a reconciliation, a report, an approval gate. Repeat next quarter with three more. A checklist reviewed once is an article; a checklist with owners and controls is a process.