Month-end billing reconciliation should explain differences between the practice's billing records and its payment evidence. A dashboard total is a starting point; closing the month requires identifying unmatched transactions, documenting corrections and assigning unresolved items to a person.
This article provides a proposed operations checklist for a therapy practice. It does not prescribe accounting treatment, payer rules or a universal financial close. The practice's biller and financial advisor should define those policies.
Choose a cutoff and record the source reports
Use one documented cutoff date and time for the review. Export or record the relevant source reports through approved access, noting the report settings and when they were obtained. A payment processor settlement period may differ from the dates shown on an invoice report; comparing them without that distinction can create a false discrepancy.
Identify whether each amount represents a charge, a client payment, a payer payment, an adjustment, a refund or a processor deposit. These are different events. A practice that sums them indiscriminately may count the same money twice or mistake a timing difference for missing revenue.
Work through the close in layers
| Layer | Compare | Example exception | Responsible reviewer |
|---|---|---|---|
| Charges | Expected billing activity and posted invoices | Visit missing from the billing queue | Biller |
| Payments | Recorded payments and payment evidence | Payment lacks an invoice association | Biller or finance lead |
| Adjustments | Approved changes and their reasons | Adjustment has no explained basis | Authorized approver |
| Refunds | Approved refund and processor result | Request exists but result is unresolved | Finance lead |
| Payer activity | Claim or remittance state and posted amounts | Remittance not yet reconciled | Insurance billing staff |
| Open differences | Previous exception log and current status | Same unresolved item carried forward | Named exception owner |
The table is an original workflow proposal. It is not a claim that every listed report is available in CallSphere or another EHR.
Explain a timing difference before correcting it
Hypothetical example: A practice records a synthetic client payment on the last day of the month. The corresponding processor deposit appears in the next month's settlement report. The team documents the date difference and checks the transaction reference before making a correction.
Deleting and re-entering the payment simply to force totals to match would make the record harder to explain. The correct action depends on the practice's accounting policy and verified transaction status, not a desire for a dashboard to display zero exceptions.
Keep an exception log that survives staff absence
Each unresolved difference needs a reference, category, amount where appropriate, owner, next action and review date. Use approved systems and limit access. Do not copy patient narratives into a general accounting spreadsheet or support email.
Separate “waiting for information” from “review complete.” If a payer response is unavailable, the item remains unresolved. If the biller believes a transaction is duplicated, record the evidence and obtain the necessary authorization before a financial change. The owner should be able to distinguish a proposed correction from a completed one.
Confirm what the software actually supports
CallSphere includes billing and insurance workflows, with configured service dependencies and staff review. Its capabilities overview identifies boundaries, including the clearinghouse connection. AI balance explanations or payment-link requests do not establish autonomous reconciliation, claim adjudication or financial sign-off.
Use a synthetic month-end set in a demo: one normal payment, one unassigned payment, one approved adjustment, one unresolved refund and one payer item awaiting information. Ask staff to locate the supporting evidence without changing real balances or sending live claims.
For background on specifying EHR workflows, consult the ASTP/ONC EHR playbook, reviewed September 9, 2026. The checklist here is the proposed evaluation artifact.
Close the review with a named sign-off
Record which reports were compared, which differences were explained and which exceptions remain open. A month can have a completed review while some items remain pending; those states should be explicit. Carry unresolved work into the next review with its owner intact.
Connect this process with self-pay estimate administration and software integration testing. Browse the billing and documentation library for related practice workflows.
