The control
25,324 lines
- 100.0% date-of-service agreement
- Both systems describe the same visits
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Case study · Outpatient PT · Diagnostic, first 30 days
Visit-to-claim reconciliation in a PT franchise network: the 887 claims the AR worklist could not see
Short answer: an AR file describes only the claims it holds. For a billing company serving a multi-state PT franchise network we joined the EMR export to the AR extract by claim number: 25,324 lines matched at 100.0%, 887 open claims had no owner, 1,626 visits had no claim.
28,873 AR lines · $6.39M · 38 clinics
Joined on claim number · Sep 17, 2026
770 lines · $141,777 already Closed
Diagnostic · no cash outcome claimed
Edition
Oct 2026
Archetype
38-clinic PT network
Metric
25,324 lines matched
Focus
Visit-to-claim join
Horizon
First 30 days
Length
5 min read
100.0%
Date-of-service agreement on the 25,324 AR lines traced to their EMR visit
887no owner
Open claims with pre-September visits that were not on the AR worklist
770lines
$141,777 open in AR but already Closed in the EMR: a posting gap
1,626visits
Arrived with no claim at all, 796 of them older than 30 days
Two files, one claim number, four exception lists
The AR baseline is published: $6.39M across 28,873 open lines on September 15, 2026. Two days later the operations report was joined to it, line by line.
What the join foundReadingAction
25,324 matched100.0% date-of-service agreement
ControlBoth systems describe the same visits
ActionWork by payer and age
770 lines, $141,777Closed in EMR, open in AR
ReadingPayment or adjustment not posted to AR
ActionPosting reconciliation, not a payer call
887 open claimsOpen in EMR, missing from AR
ReadingPre-September visits; nobody owns the follow-up
ActionAdd to the worklist with an owner and a date
1,626 visitsArrived, no claim
ReadingDocumentation not finalized; 796 past 30 days, filing clock running [1]
ActionUnsigned-note list to the clinic daily
TakeawayA claim open in the EMR and absent from the AR worklist ages without a single touch. Only the join shows it.
Same claim, two statuses
| EMR status of the AR line | Count | Reading | Action |
|---|---|---|---|
| Open in both | 25,324 traced | Live claim, both systems agree | Work by payer and age |
| Closed in the EMR, open in AR | 770 lines, $141,777 | Payment or adjustment not posted to AR | Posting reconciliation, not a payer call |
| Open in the EMR, missing from AR | 887 pre-September claims | Nobody owns the follow-up | Add to the worklist with an owner and a date |
Does each month catch up to the ninety-percent line?
Share of billed visits closed, by service month, as of September 17, 2026
Recent months read lower while claims adjudicate; the test is whether each climbs to the line. Open inventory: 33,113 claims, 9.7% over a year old. Closed includes claims moved to patient balance.
90.2%at the lineNov 202510 months old
84.5%5.5 pts shortMar 20266 months old
78.3%11.7 pts shortJun 20263 months old
52.7%37.3 pts shortAug 20261 month old
Reached 90%Still adjudicatingThe month to watch
Growth is where the leak hides
Scheduling funnel, March to August 2026: 89,960 scheduled
Same-store arrived visits up 48.6% year over year, 6,181 to 9,188 in August: more places for a claim to go missing.
Arrivedabout 76,900 visits
85.5%1,626 of these had no claim
Cancelled by patientabout 10,100
11.2%
No-showabout 1,700
1.9%
Arrived, no claimSeptember 17 snapshot
1,626 visits100% of the unbilled list
Of which older than 30 daysfiling clock running
796 visits49% of the unbilled list
ArrivedPatient cancelledLost or unbilled
Visits that end early, and lines worked per day
Median visits per plan of care
Sep 2025 to Aug 2026; 26.3% of discharges were patients who stopped attending
12 visitsCompleted plan100%
5 visitsStopped attending42% of a full plan
AR lines worked per person per day
August against September 2026, first month under the weekly join; labeled early
34.2August65% of September
52.5September100%
The reconciliation routine, no new software
1
Weekly join
Operations export joined to the AR extract every week; exception lists refreshed: closed-in-EMR, missing-from-AR, arrived-no-claim.
2
Posting before calls
Lines already Closed in the EMR go to posting reconciliation; a payer call about a paid claim wastes the slot.
3
Owner for every open claim
Claims open in the EMR but absent from AR join the worklist with a named owner.
4
Unsigned-note list per clinic
Arrived visits with no claim go to the clinic daily, oldest first; escalated to the director after a week.
5
Closure curve by month
Each service month tracked until it reaches the ninety-percent line, so a slow month is visible while it can be fixed.
Four lists no aging report contains
Posting gap
770 lines, $141,777
- Closed in the EMR, still open in AR
- 34% of worked lines in month one were already paid
No owner
887 claims
- Open in the EMR, absent from the AR worklist
- Not yet released, held or in review
No claim
1,626 visits
- 796 older than 30 days
- Medicare allows one calendar year from service [1]
Reported as measured, including what has not moved
- $0No cash or net collection outcome yetNo payment file supplied; results follow when measurable.
- 1 moThe productivity gain is one month old34.2 to 52.5 lines per person per day is labeled early for that reason.
- JoinClinics in one file only were not reconciledThe join covers the 25,324 traceable lines.
- AugAugust 2026 has not reached November 2025Success is August at 90%; not yet.
Takeaway
An AR file can only describe the claims it holds. The claims nobody owns and the visits that never became claims live in the join, and nowhere else.
Frequently asked questions
What is a visit-to-claim reconciliation?
A line-by-line join of the EMR operations export to the AR extract on claim number. It checks both systems describe the same visits, then lists exceptions: AR lines closed in the EMR, claims open in the EMR but missing from AR, arrived visits with no claim. Here 25,324 lines matched at 100% date-of-service agreement.
How can a claim be open but missing from the AR worklist?
The AR extract only includes claims that reached a billable state. Claims created in the EMR but not yet released, held or in review are open in the practice system and absent from AR. Here 887 such claims had visits before September, so no one followed them up.
Why does the share of visits closed fall in recent months?
Recent claims are still adjudicating, so August always reads lower than November on the same date. The test is whether each month climbs to the level older months reached: November 2025 at 90.2%, August 2026 at 52.7% on September 17, 2026.
Why track plans of care in a billing review?
A patient who stops after five visits instead of twelve is seven claims that never happen; 26.3% of discharges here stopped attending. Medicare and many commercial plans require a claim within one year of service, so an undocumented visit also runs a filing clock.
Checked October 27, 2026. Rules change; confirm against the source. Engagement figures are from ASP-RCM records and the client's own exports; the client is described by type only.
ServicePhysical therapy billing services
Case studyThe baseline: $6.39M of PT accounts receivable
Case studyPT front desk: 3,976 short visits
InsightOutpatient therapy denial codes: the CARC map
BlogKX modifier documentation checklist
White paperPT billing services vendor scorecard
MatrixTherapy payer policy matrix
Join your visits to your claims
Send the operations export and the AR extract from your practice system. We match them line by line and show the claims nobody owns and the visits that never became claims.