The September Revenue Cycle Audit: What Every Medical Practice Should Review Before Q4

September is more than the final month of the third quarter. For medical practices, it is an opportunity to examine whether the revenue cycle is actually producing the financial performance that the practice expects before the final quarter begins.

Waiting until December to discover that claims are aging, denials are recurring, payer payments are changing, or provider enrollment information is outdated can make corrective action considerably more difficult.

A September revenue cycle audit does not need to be a massive financial exercise. It should be a focused review of the points where revenue is most likely to be delayed, reduced, or lost.

That review is particularly relevant in 2026. The Medical Group Management Association (MGMA) reported in June that 84% of medical groups surveyed had higher year-to-date operating costs than the previous year, with respondents reporting an average increase of approximately 11%. At the same time, a July MGMA survey found that only 47% of groups reported higher year-to-date revenue, while 36% reported lower revenue.

In that environment, Q4 planning requires more than a revenue projection. It requires confidence that the revenue already earned is being captured correctly.

1. Start With the September Revenue Cycle Audit, Not the Year-End Numbers  

A traditional financial review may focus on:

• Total revenue

• Expenses

• Net income

• Cash balance

Those figures are important, but they do not necessarily explain why revenue is moving in a particular direction.

A September revenue cycle audit should trace revenue from the patient encounter through final payment:

Registration → Eligibility → Authorization → Documentation → Coding → Charge Capture → Claim Submission → Adjudication → Payment Posting → AR Follow-Up

The objective is to identify where revenue is being delayed or lost before those problems become Q4 financial surprises.

MGMA's January 2026 research found that practices identified denials and appeals as their largest source of revenue-cycle leakage at 48%, followed by front-end issues at 23%, billing and collections at 14%, coding at 13%, and charge posting at 2%.

That provides a useful framework for deciding where an audit should begin.

2. Review Accounts Receivable Aging  

AR should be one of the first areas reviewed before entering Q4.

Look beyond the total AR balance and examine its composition.

Review:  

• Current AR

• 31–60 day AR

• 61–90 day AR

• 91–120 day AR

• AR over 120 days

• Payer-specific aging

• Patient-responsibility aging

• Denial-related AR

• Unbilled or suspended claims

The important question is not simply:

"How much money is outstanding?"

It is:

"How much of that money is realistically collectible, and what is preventing collection?"

A growing percentage of older AR may indicate that the practice is generating revenue but failing to convert it into cash efficiently.

3. Identify Claims Approaching Filing Deadlines  

September is an appropriate time to examine older unpaid and unresolved claims before Q4 begins.

Review claims that are:

• Still pending

• Rejected

• Denied

• Awaiting corrected submission

• Awaiting medical records

• Awaiting payer review

• Approaching timely-filing limits

A claim that remains unresolved for months becomes progressively more difficult to recover.

The audit should therefore identify high-risk claims that require immediate action, rather than simply reporting the total number of outstanding claims.

4. Analyze Denials by Root Cause  

A denial report becomes much more useful when it answers why claims are being denied.

Categorize denials by:

• Eligibility

• Authorization

• Referral

• Coding

• Modifier

• Documentation

• Medical necessity

• Timely filing

• Credentialing

• Coordination of benefits

• Payer processing error

MGMA's 2026 research found that practices are dealing with denial leakage involving medical necessity, non-covered services, bundling and global-package edits, utilization management, eligibility and coordination-of-benefits problems, timely filing, credentialing, and payer errors.

The key September question:  

Which denial category is repeatedly appearing—and what process is allowing it to continue?

A denial that occurs once may be an isolated event.

A denial category that appears repeatedly is usually a workflow issue.

5. Review Clean Claim Performance  

A high volume of claims does not necessarily indicate an efficient billing operation.

Review:

• Clean claim rate

• Initial rejection rate

• Initial denial rate

• Corrected claim volume

• Claim resubmission volume

• Average time from encounter to claim submission

HFMA materials commonly use clean-claim and denial metrics as core revenue-cycle performance indicators. One HFMA presentation lists a clean-claim benchmark of at least 98% and an initial denial target below 5%; practices should treat such figures as reference points rather than universal requirements because performance varies by specialty, payer mix, and workflow.

The more important objective is to establish a reliable baseline and understand why performance changes.

6. Compare Expected Reimbursement With Actual Payment  

This is one of the most valuable—and frequently overlooked—parts of a revenue cycle audit.

A claim can be marked paid while still being underpaid.

Review whether actual reimbursement aligns with:

• Contracted rates

• Applicable fee schedules

• Modifier rules

• Units billed

• Patient responsibility

• Contractual adjustments

Look for recurring payer variances rather than isolated payment differences.

A practice that monitors only denied claims may miss revenue leakage from claims that were successfully processed but incorrectly reimbursed.

7. Review Payer Performance Before Q4  

Payer performance can change over time, and September provides an opportunity to examine trends before final-quarter planning.

Compare payers on:

• Average reimbursement

• Denial rate

• Days to payment

• AR aging

• Underpayment frequency

• Authorization-related denials

• Eligibility-related denials

This can reveal whether changes in payer mix or reimbursement behavior are affecting the practice's financial performance.

MGMA reported in July 2026 that practices with flat or declining revenue cited reimbursement pressure, payer mix changes, denials, and downcoding among the factors affecting financial performance.

8. Verify Provider Enrollment and Credentialing Status  

Q4 revenue can be affected by provider enrollment issues that began months earlier.

Review:

• Provider enrollment status by payer

• Effective dates

• Group affiliations

• Practice locations

• NPI information

• Recredentialing deadlines

• License expiration dates

• Malpractice coverage

• CAQH information where applicable

A provider who is clinically active but has an unresolved payer enrollment issue can create claims and reimbursement complications.

This is especially important when new providers have been added during the year.

9. Review Prior Authorization and Referral Performance  

Authorization problems should be evaluated before Q4 rather than discovered through future denials.

Review:

• Services requiring authorization

• Authorization approval rates

• Expired authorizations

• Remaining authorized visits or units

• Referral requirements

• Authorization-related denials

• Authorization documentation

MGMA's 2026 research identified prior authorization and referral requirements among significant sources of front-end revenue leakage.

For recurring services, the review should also verify that authorization limits are being tracked against actual utilization.

10. Examine Coding and Documentation Trends  

The September audit should include a targeted coding review rather than simply checking whether claims were submitted.

Look for:

• Repeated coding corrections

• Modifier-related denials

• Undercoding patterns

• Missed billable services

• Documentation gaps

• Inconsistent coding between providers

• Payer-specific coding issues

MGMA reported that practices in 2026 were identifying undercoding, particularly among E/M services, missed codes, modifier problems, and documentation deficiencies as sources of revenue leakage.

The goal is not to increase coding levels indiscriminately.

The goal is to ensure that documented services are accurately and compliantly represented on the claim.

11. Check Charge Capture and Unbilled Encounters  

A service cannot be reimbursed if it never reaches the claim.

Review:

• Completed encounters without charges

• Delayed charge entry

• Missing charges

• Unsigned or incomplete documentation

• Encounters sitting in billing queues

• Services held because of unresolved chart issues

Charge capture problems may be small on an individual encounter but significant across an entire quarter.

12. Review Patient Responsibility  

Patient financial responsibility deserves particular attention before Q4.

Analyze:

• Copay collection rates

• Deductible balances

• Coinsurance

• Patient AR aging

• Payment plans

• Failed payment arrangements

• Point-of-service collection performance

MGMA's January 2026 research identified high deductibles, rising patient responsibility, failed payment plans, and outdated collection methods as important contributors to billing and collection leakage.

This becomes particularly relevant when preparing for the following year's deductible cycle.

13. Review Payment Posting and Reconciliation  

A practice should confirm that payments received are being posted accurately and promptly.

Review:

• ERA/EOB posting accuracy

• Unapplied payments

• Incorrect contractual adjustments

• Duplicate postings

• Refund balances

• Credit balances

• Patient payments

• Bank-to-system reconciliation

Delayed or inaccurate payment posting can distort AR reporting and make financial performance appear better or worse than it actually is.

14. Review Medicare and Other Fee Schedule Changes  

Q4 planning should not assume that reimbursement remains static.

CMS continues to issue updates to the Medicare Physician Fee Schedule throughout the year. For example, CMS implemented a July 2026 quarterly update that included new codes, procedure-status changes, descriptor revisions, and payment-policy indicator changes. CMS also released the CY 2027 Physician Fee Schedule proposed rule on July 14, 2026.

Practices should therefore confirm that:

• Current fee schedules are loaded correctly

• Relevant code changes have been incorporated

• Billing systems reflect applicable updates

• Internal reimbursement assumptions remain current

For practices with substantial Medicare volume, this review can materially improve Q4 forecasting.

15. Measure the Right Revenue Cycle KPIs  

A September audit should produce a concise KPI dashboard rather than dozens of disconnected numbers.

At minimum, consider monitoring:

KPI	What It Reveals
Days in AR	How quickly revenue is converted to cash
AR over 90 days	Potential collection risk
Initial denial rate	How frequently claims fail at first adjudication
Clean claim rate	Front-end and claim-submission quality
Net collection rate	Effectiveness of revenue capture
Charge lag	Delay between service and billing
Denial overturn rate	Effectiveness of appeals
Underpayment variance	Payment accuracy
Patient collection rate	Performance of patient-responsibility collections
Revenue per encounter	Financial value of clinical volume

The objective is not to pursue a particular benchmark blindly.

The objective is to identify deterioration, recurring problems, and opportunities for improvement before Q4 closes.

16. Turn Audit Findings Into a Q4 Action Plan  

The audit becomes valuable only when findings lead to action.

Each issue should be assigned:

• Root cause

• Financial impact

• Responsible team

• Corrective action

• Deadline

• Follow-up metric

For example:

Problem: Increasing authorization denials

Root cause: Authorization expiration not tracked consistently

Action: Add expiration monitoring to scheduling workflow

Owner: Authorization team

Q4 metric: Authorization-related denial rate

This converts an audit from a retrospective exercise into an operational improvement program.

17. What Healthcare Leaders Should Know Before Q4  

By the end of September, leadership should be able to answer:

Revenue  

• Are collections tracking against expectations?

• Is revenue per encounter changing?

• Are payer reimbursement patterns shifting?

AR  

• How much AR is over 90 days?

• Which payer or service line has the greatest exposure?

• Which claims require immediate escalation?

Denials  

• What are the top three denial causes?

• Are those causes increasing or decreasing?

• Which problems can be prevented upstream?

Providers  

• Are all providers properly enrolled?

• Are credentialing or effective-date issues affecting claims?

Operations  

• Is billing capacity sufficient for current volume?

• Are manual processes creating avoidable rework?

Q4 Planning

  

• What revenue is realistically collectible before year-end?

• What unresolved issues could materially affect Q4 cash flow?

Conclusion  

A September revenue cycle audit is not simply a pre-year-end cleanup exercise. It is an opportunity to determine whether the practice's revenue infrastructure is strong enough to finish the year effectively.

In 2026, that assessment is particularly important as medical practices face a difficult combination of rising operating costs, reimbursement pressure, denial challenges, and changing patient financial responsibility. MGMA's recent data illustrates the tension clearly: operating costs are rising across most medical groups, while revenue growth is not keeping pace for many organizations.

The most useful September audit therefore asks more than "How much did we bill?"

It asks:

What did we earn, what has actually been collected, what remains at risk, and what can we fix before Q4 ends?

That distinction can give practice leaders a far more reliable basis for budgeting, staffing, payer strategy, and financial planning.

A strong Q4 does not begin in December.

It begins with knowing exactly where the revenue cycle stands in September.