Your practice management software is ground zero for tracking insurance reimbursements. Every claim gets submitted with procedure codes and charges, and the system tracks status from submission through payment. The accounting side comes later, but if your PM system isn’t capturing claims correctly from the start, your financial records will never be right.

Track four things for every encounter: what you billed, the contractual adjustment, what insurance paid, and patient responsibility. The contractual adjustment is the difference between your charge and the allowed amount under your contract with that payer. If you bill $200 but your contract allows $120, that $80 is an adjustment, not a collection problem. Many practices overstate their accounts receivable because they don’t record these adjustments until payment arrives.

Match EOBs to claims when payments arrive. The Explanation of Benefits shows exactly what the payer allowed, what they paid, and what the patient owes. Post these details to each patient account so your receivables reflect reality. Bulk-depositing insurance checks without posting the detail means your aging reports are fiction.

Reconcile your practice management reports with your accounting software at least monthly. Your PM system knows which claims are outstanding. Your accounting system knows what cash you deposited. When these don’t match, you can’t trust either one. Healthcare practice bookkeeping requires understanding both the clinical billing workflow and how it connects to your general ledger.

Run aging reports weekly and work claims over 30 days. Insurance companies deny claims for fixable reasons, process them incorrectly, or simply lose them. Without systematic follow-up, money sits in limbo until it’s too late to collect. Most practices could improve collections by 5-10% just by following up consistently on unpaid claims.

Patient balances after insurance need their own process. The $35 copay that didn’t get collected and the $180 deductible after insurance paid both become patient AR. These smaller balances get ignored because they’re tedious to chase, but they represent real revenue that adds up over a year.

A practice generating $50,000 monthly in charges might have $150,000 or more in outstanding receivables at any given time. Without proper tracking, you don’t know if that’s normal for your payer mix or a sign of collection problems. Getting the reconciliation right requires someone who understands both systems. An Andover, MA payroll service that works with healthcare practices can keep your practice management data connected to your accounting so your financial statements reflect what’s actually happening with collections.