Year-End Revenue Checklist for 2026
The last eight weeks of the year decide how much of 2026 you actually collect — and how smoothly 2027 starts. This issue explains what to clean up, what changes in January, and how to plan the next eight weeks.
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From the desk. Over the last two issues we covered credentialing and denial prevention. This month we bring everything together into one year-end plan.
Print it, assign an owner to each line, and check items off as you go. Every task here protects revenue you’ve already earned.
At a glance
- Work A/R in the 61–120 day range first — it’s still recoverable, but time is running out.
- Sweep for claims close to timely filing limits; Medicare’s is 12 months from the date of service.
- Compare what payers paid against your contracts — underpayments are easy to miss.
- Most deductibles reset January 1, so re-verify eligibility and update cost estimates.
- CPT updates take effect January 1; update charge masters, templates and scrubber rules now.
Regulatory & industry watch
CMS usually publishes the final Physician Fee Schedule for the coming year in early November. Once it’s out, compare the new rates for your top 20 codes against 2026, and check for changes to policies that affect your specialty, such as telehealth, supervision or add-on codes.
New, revised and deleted CPT codes take effect on January 1, 2027. Claims for 2027 dates of service with deleted codes will reject. Our guide to CPT, ICD-10 and HCPCS codes explains how the three code sets fit together.
Under the No Surprises Act, providers must give uninsured and self-pay patients a Good Faith Estimate of expected charges when they schedule care in advance or ask for one. As patients change plans in January, make sure your front desk knows when an estimate is required.
01Clean up accounts receivable
Old A/R doesn’t get easier to collect in January. The older a balance gets, the less likely it is to be paid at all.
Accounts receivable (A/R) is the money owed to your practice for services already provided — by insurers and by patients. The key measure is days in A/R: your total A/R divided by your average daily charges. If you have $300,000 in A/R and charge an average of $10,000 a day, you’re at 30 days. Many practices aim for under 40.
Start by pulling an aging report by payer and by bucket (0–30, 31–60, 61–90, 91–120 and 120+ days). Then work in this order:
- 61–120 days, highest dollars first. These are still recoverable but close to appeal and filing limits.
- Any claim with no response after 45 days. Call or check the portal, and record the status and reference number.
- Open denials — resubmit or appeal before their windows close.
- Credit balances — review and resolve overpayments and refunds before year-end.
- Patient balances — send final statements and offer payment plans where needed.
For a full process, see our guide on how to reduce A/R days in 7 steps. Accurate posting matters too — read how inaccurate payment posting warps practice financials.
02Beat timely filing deadlines
Every payer sets a deadline for submitting claims, counted from the date of service. Miss it and the claim is denied (usually CO-29), and in most cases it can’t be recovered. Claims for services from late 2025 and early 2026 are now close to many payers’ limits.
| Payer type | Typical filing limit | Action now |
|---|---|---|
| Medicare | 12 months from date of service | Find unbilled or rejected claims from late 2025 and early 2026 |
| Medicaid | Varies by state | Check your state’s rule and any open claims near the limit |
| Commercial payers | Often 90–180 days, set by contract | Confirm each contract’s limit; prioritize the shortest |
| Secondary claims | Often counted from the primary’s payment date | Bill secondaries as soon as primary payments post |
Keep proof of timely submission. Clearinghouse acceptance reports are your best evidence if a payer later denies a claim for timely filing. Our clearinghouse guide explains which reports to save.
03Catch underpayments
An underpayment is when a payer pays less than your contract says it should. It doesn’t show up as a denial, so it’s easy to miss — the claim looks “paid,” but money is still missing.
Common causes include outdated fee schedules loaded at the payer, incorrect modifier reductions, multiple-procedure discounts applied wrongly, and contract rate increases that were never put in place. Year-end is a good time to compare the allowed amounts on your ERAs against your contracted rates for your highest-volume codes.
- Pick your top 20 CPT codes by volume and check what each major payer actually allowed in 2026.
- Compare against the contract — including any escalators that should have taken effect this year.
- Dispute variances in writing, with the contract language attached.
- Calendar contract renewal dates so you can renegotiate rather than auto-renew.
Learn more in our payer contract management guide and our explainer on contractual adjustments. If you suspect a pattern, our underpayment recovery services can audit and recover it.
04Prepare for January resets
For most calendar-year health plans, patient deductibles reset on January 1. That means patients owe more out of pocket for early-year visits, and practices that don’t collect at the time of service end up with a surge of small patient balances that are hard to collect later.
- Update cost estimates so front-desk staff can quote patient responsibility accurately.
- Ask every patient for their current card at their first visit of the year, even if they say nothing changed.
- Refresh your financial policy and have patients sign the updated version.
- Train staff on collecting at check-in, including how to explain deductibles politely.
Make sure your approach follows the rules — see how to handle patient balances legally and ethically and our eligibility verification best practices. A strong front office makes January much smoother.
05Update codes & fee schedules
New year, new codes. If your systems aren’t updated before your first 2027 claims go out, you’ll see rejections and denials in the first weeks of January — exactly when cash flow is already tight because of deductible resets.
- Review new, revised and deleted CPT codes for your specialty and update your charge master.
- Compare your fee schedule against the final 2027 Medicare rates and your top commercial contracts. Make sure your charges aren’t below what any payer allows.
- Update superbills, EHR templates and scrubber rules before the first claim of 2027.
- Confirm FY2027 ICD-10-CM codes (effective October 1, 2026) are already in use.
- Review add-on codes you rely on, such as G2211 with office visits — see our 99214 guide for how it’s used.
06MIPS & quality reporting
If your clinicians participate in Medicare’s Merit-based Incentive Payment System (MIPS), the 2026 performance year ends on December 31. Data submission typically runs from early January through March 31 of the following year. Your MIPS score affects your Medicare payments in a later year, so gaps now can cost money down the line.
Before year-end, check that quality measures are being captured in your EHR, that improvement activities are documented, and that any required security risk analysis is complete. Our guide to navigating MIPS in 2026 covers the categories and how to avoid a penalty.
07Example: what clean-up is worth
A three-provider practice has $240,000 in insurance A/R. Of that, $62,000 is older than 90 days. After a six-week year-end push:
• $18,000 in claims are found never to have been submitted or were stuck in rejections, and are billed within filing limits.
• $14,000 in denials are corrected or appealed successfully.
• $5,500 in underpayments are identified against one payer’s contract and disputed.
That’s roughly $37,500 recovered that would very likely have been written off in 2027 — and the practice starts January with clean A/R.
Figures are illustrative only. Results depend on your payer mix, volume and current A/R.
Most of that work didn’t need new systems — just focused time, a clear priority order and consistent follow-up. Find out where else revenue escapes in 7 causes of revenue leakage.
08Your 8-week countdown
| When | Focus | Owner |
|---|---|---|
| Weeks 1–2 | A/R aging review, timely-filing sweep, open denial list | Billing lead |
| Weeks 3–4 | Appeals and resubmissions; underpayment review; patient statements sent | Billing team |
| Weeks 5–6 | CPT and fee schedule updates; credentialing renewals due in Q1; MIPS check | Coding & credentialing |
| Weeks 7–8 | Front-desk training for January; final payment posting and reconciliation | Practice manager |
Frequently asked questions
What’s a good number of days in A/R?
Many practices aim to keep days in A/R under 40, and the share of A/R older than 90 days under about 15–20%. Benchmarks vary by specialty and payer mix, so the trend over time matters more than a single number.
Can we still bill a claim that’s past the timely filing limit?
Usually not. The main exception is when you can prove the claim was originally submitted on time — for example, with a clearinghouse acceptance report — or when the payer has a specific exception. That’s why keeping submission proof is so important.
Should we write off small patient balances at year-end?
Only under a consistent, written policy. Writing off balances inconsistently, or routinely waiving copays and deductibles, can create compliance problems with payer contracts and federal programs. Set a clear policy and apply it the same way for every patient.
When will the 2027 Medicare fee schedule be available?
CMS usually releases the final Physician Fee Schedule in early November, with rates effective January 1. Your MAC will publish the locality-specific rates.
Do we need to collect deductibles at the time of service?
You’re not required to, but collecting known patient responsibility at check-in is one of the most effective ways to protect cash flow in the first quarter. Make sure the amount is based on a current eligibility check.
Key dates & rules to remember
| Date / rule | What it means |
|---|---|
| Early November | CMS typically releases the final CY2027 Physician Fee Schedule |
| December 31, 2026 | End of the 2026 MIPS performance year |
| January 1, 2027 | 2027 CPT codes take effect; most plan deductibles reset |
| By March 31, 2027 (typically) | MIPS data submission for the 2026 performance year |
| 12 months from DOS | Medicare timely filing limit |
Related resources
This newsletter is for general information only and is not legal, financial or compliance advice. Payer rules and deadlines vary — always confirm requirements with the payer or your MAC.
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