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Have you ever been playing a board game like Monopoly or Catan, feeling like you’re absolutely crushing it, only to realize you missed a rule that flips the entire game on you? That disoriented feeling is exactly what happens in a practice when you ignore "accumulations."  In the billing world, we often treat an eligibility check like a one-and-done task. But here’s the reality: an eligibility check is just a snapshot in time. It tells you what the benefits were for that brie

We’ve all been there. You’re looking at your billing for the month, and suddenly your heart sinks. You realize you’ve seen a patient for five sessions, but nobody ever got the green light from the insurance company. In a moment of panic, you think, “Maybe we can just call them and get a retroactive authorization?” . In the billing world, we call this the “Retro-Auth,”  but I’m going to be the bearer of some hard news today: for most practices, the retro-auth is a total myth.

You just want to get paid for your incredible clinical work, but the insurance company seems to make the process impossible. You call a payer, verify that the patient's coverage is "active" (yes!), and submit the claim, only to have it come back months later as a dead-on-arrival (DOA) denial. The E&B (Eligibility and Benefits) check should never be skipped, but simply confirming coverage is "active" is not enough. This crucial step is not a simple light switch, and relying on

You spend precious administrative hours verifying eligibility and benefits (E&B) for every new patient, only for a handful of those claims to come back denied anyway. It’s frustrating when you feel like you've checked all the boxes, yet revenue still slips through the cracks—it's the billing equivalent of a "check engine" light. Here’s the sobering reality, straight from our Billing Director, Kelley Sonnenberg: Eligibility and benefit checks are only about 70% accurate across