Understanding the Limitations of Your EHR

Why EHRs Fall Short in Revenue Cycle Management

Even popular systems like TherapyNotes, Tebra/Kareo, eClinicalWorks, AdvancedMD, and Modernizing Medicine fall short when it comes to actual revenue insight. That’s because:

• They flag rejections, but don’t ensure follow-up.

• They don’t interpret payer-specific coding guidance.

• Most billing companies just submit what was entered — errors and all.

• System reports rarely show what’s missing — only what’s submitted.

  
  

The bottom line is clear: if you’re only looking at what got billed, you’re missing what didn’t.

Real-World Revenue Gaps We See Weekly

When we onboard a new client, we don’t just review their claims — we audit their entire billing flow. Here’s what we regularly uncover:

• A Tebra user had over 75 encounters marked “Ready to Bill” that were never submitted — simply because no one was monitoring the queue.

• A provider on AdvancedMD was unknowingly defaulting every follow-up session to 90832, underbilling by 25% per visit.

• An eCW user had rejection filters turned off — so denied claims quietly aged out without notice.

• One practice was using the wrong Place of Service (POS) code for telehealth, resulting in consistent Medicaid denials.

• Multiple clients were missing modifier 95 or other required modifiers — triggering unnecessary denials and manual work.

  
  

These aren’t flukes. They’re the norm when no one is proactively checking.

We Don’t Just Submit Claims — We Translate Payer Rules

Here’s what sets us apart from typical billing vendors:

Modifier Review

We verify what each payer expects. Modifier 95, 25, 59 — we don’t guess. We check.

POS Alignment

We ensure the Place of Service matches payer-specific guidelines for Medicaid, commercial, and telehealth sessions.

EHR Scrubbing

We monitor “Ready to Bill” queues, denial folders, and clearinghouse rejections that go ignored by default.

Payer Mapping & NPI Logic

We review how your system sends rendering vs billing NPI data — and whether your claims are routed correctly from the start.

This kind of front-to-back review catches what your EHR can’t. And what your last billing company probably didn’t.

Platforms We Know Inside and Out

We’re not just billing “compatible” with your system — we know how to optimize them:

• TherapyNotes – Claim submission workflows, time code use, clearinghouse error resolution.

• Tebra/Kareo – Queue monitoring, default charge review, eligibility alignment.

• eClinicalWorks (eCW) – Custom filters, payer mapping, Medicaid troubleshooting.

• AdvancedMD / ModMed – Charge review, claim logic cleanup, denial trend analysis.

  
  

Don’t Trust Reports Alone. Demand Revenue Visibility.

Your EHR isn’t an RCM platform. It can’t think. It won’t audit. It doesn’t correct provider coding. And it definitely won’t follow up when a claim gets ignored.

That’s where we come in.

Want a Free Claim or Workflow Review?

We’ll look behind your dashboards and show you exactly where revenue is leaking — no strings attached.

By understanding the limitations of your EHR and actively managing your revenue cycle, you can significantly improve your practice's financial health. Don't let unnoticed claims and underbilled visits affect your bottom line. Take control of your revenue cycle today.

For more insights on optimizing your practice's revenue cycle management, check out our resources here.