How to Stop Losing Money to Unbilled Services in Jane.app
23% of completed appointments at Jane.app clinics have at least one unbilled service. That's nearly 1 in 4 appointments generating less revenue than they should.
For a typical clinic with 350 appointments per month, that's 80 appointments leaving money on the table—an average of $3,800 per month or $45,600 per year in revenue that was earned but never captured.
The frustrating part? You did the work. The patient received the service. The clinical notes were documented. But somehow, the invoice was never completed or was missing key services.
This guide will show you exactly how unbilled services happen in Jane.app, how to catch them before they become write-offs, and how to prevent them from happening in the first place.
Why Unbilled Services Happen (It's Not Your Staff's Fault)
Before we fix the problem, let's understand why it happens. Unbilled services aren't the result of lazy staff or poor training—they're the natural outcome of busy clinics relying on manual handoffs.
Scenario 1: Multi-Provider Same-Day Visits
What Happens: Patient books a chiropractic adjustment. During the appointment, the chiropractor recommends adding massage therapy. Patient agrees and goes directly from the adjustment table to the massage room.
Where the Billing Breaks Down:
- Chiropractor updates their clinical notes but doesn't notify front desk
- Patient bypasses front desk between appointments
- Massage therapist sees patient, provides service, documents in notes
- Front desk creates invoice for chiro only (what was originally booked)
- Massage service never gets added to invoice
Result: $75-$95 massage service unbilled
Frequency in Multi-Disciplinary Clinics: 34% of same-day multi-provider visits have this issue
Scenario 2: Treatment Time Extensions
What Happens: Patient books a 30-minute massage. During treatment, therapist identifies trigger points requiring additional work. Session runs 52 minutes instead of 30.
Where the Billing Breaks Down:
- Therapist finishes session, patient checks out
- Front desk bills for 30-minute session (what was booked)
- No one thinks to check if actual duration exceeded booked duration
- 22 extra minutes of service provided but not billed
Result: Under-billed by $30-$40 (depending on clinic's time-based pricing)
Frequency: 19% of appointments run longer than booked time
Scenario 3: Add-On Services Mid-Session
What Happens: Patient comes in for standard adjustment. Chiropractor decides cupping or dry needling would help. Provides the add-on service during the same appointment.
Where the Billing Breaks Down:
- Chiropractor documents add-on in clinical notes
- Patient checks out before practitioner updates Jane.app appointment details
- Front desk sees only the originally booked service
- Add-on service sits in clinical notes but never makes it to invoice
Result: $25-$45 add-on service unbilled
Frequency: 18% of appointments have undocumented add-on services
The $2,400/Month Calculation (Your Clinic's Numbers)
Let's calculate your specific unbilled services leak:
Step 1: Pull your Scoreboard report (Reports > Appointments > Scoreboard)
- Date range: Last 30 days
- Filter: Status = "Arrived"
- Count: __________ arrived appointments
Step 2: Pull your Payments report (Reports > Accounting > Payments)
- Date range: Same 30 days
- Count unique invoices: __________
Step 3: Calculate the gap
- Arrived appointments: __________
- Invoices: __________
- Unbilled appointments: __________ (arrived - invoices)
Step 4: Estimate monthly leak
- Unbilled appointments: __________
- × Average service value: $95
- = Monthly unbilled services leak: $__________
Step 5: Annualize it
- Monthly leak: $__________
- × 12 months
- = Annual unbilled services leak: $__________
Industry Average: For a 350-appointment/month clinic, the average is 80 unbilled appointments ($7,600/month = $91,200/year). If yours is higher, don't panic—it's fixable.
Solution 1: Daily Reconciliation Workflow (Manual, Free)
The simplest fix is a daily end-of-day reconciliation checklist. This catches unbilled services within 24 hours while memory is fresh and corrections are easy.
The 10-Minute Daily Checklist
Timing: Last 10 minutes before closing
Responsible: Front desk or billing coordinator
Process:
Step 1: Pull Today's Arrivals (2 minutes)
Reports > Appointments > Scoreboard
Date: Today
Filter: Status = "Arrived"
Export to CSV (optional)
Result: List of every patient who showed up today
Step 2: Cross-Check Invoices (5 minutes)
For each "Arrived" appointment:
- Open the appointment in Jane
- Click "View Invoice" (or "Create Invoice" if none exists)
- Ask these 3 questions:
- ✅ Does an invoice exist?
- ✅ Does the invoice match the services documented in clinical notes?
- ✅ Does the invoice match the actual treatment duration?
Step 3: Flag Discrepancies (2 minutes)
When you find a mismatch:
- Add a note to the appointment: "CHECK BILLING - possible unbilled service"
- Tag the practitioner: "@DrSmith - did patient receive massage after adjustment?"
- Set a follow-up task for next morning
Step 4: Resolve Next Morning (5 minutes)
- Review flagged appointments from yesterday
- Contact practitioners if needed
- Update invoices while memory is fresh
- Send adjusted invoice to patient (or apply to account if already paid)
Expected Results:
- Week 1: Catch 60-70% of unbilled services (learning curve)
- Week 2-4: Catch 85-95% of unbilled services (staff proficient)
- Ongoing: Requires 10 min/day discipline, results fade if checklist is skipped
Solution 2: Multi-Provider Handoff Protocol
If you run a multi-disciplinary clinic (chiro + massage, physio + naturopathy, etc.), you need a documented handoff protocol for same-day multi-provider visits.
The "Service Addition Form" System
When to Use: Any time a patient will see multiple practitioners in one visit (planned or unplanned)
How It Works:
1. First Practitioner Documents Intent
Before patient leaves first treatment room:
- Jane.app: Add appointment note: "Referred to [Provider Name] for [Service Type]"
- Physical: Fill out laminated "Service Addition Form" (½ sheet, attached to clipboard)
- Alert: Text or message front desk: "Multi-provider alert - check appointment notes"
2. Front Desk Updates Appointment
When notified:
- Open patient's appointment in Jane
- Add second service to the same appointment (don't create separate appointment)
- Or: Create linked follow-up appointment for same day
- Critical: Update appointment status to "Multi-Provider" (use custom tag if needed)
3. Second Practitioner Confirms Services
After completing treatment:
- Review appointment in Jane to confirm both services are listed
- If not listed, immediately message front desk before patient checks out
4. Front Desk Creates Unified Invoice
At checkout:
- Verify all services from the day are on one invoice
- Review appointment notes for any documented add-ons
- Ask patient: "You saw [Provider 1] and [Provider 2] today, correct?"
Templates You Can Swipe:
Service Addition Form (physical clipboard version):
🏥 MULTI-PROVIDER SERVICE ADDITION
Patient: ______________________ Date: __________
First Provider: ________________ Service: _______________
Referred to: ___________________ Service: _______________
☐ Front desk notified
☐ Jane appointment updated
☐ Second service added to invoice
Front Desk Initial: ___________ Time: __________
Solution 3: Treatment Duration Monitoring
Catch time-based under-billing before patient checks out.
Jane.app Feature to Enable
Settings > Appointments > Track Actual Duration
When enabled, Jane tracks when appointments actually start and end (based on clinical note creation/completion times).
Front Desk Checkout Question
Add this to your checkout script:
"Your appointment was scheduled for [X minutes]. You were with [Provider] for [Y minutes]. Let me make sure the invoice reflects the full time."
When to Adjust:
- Booked: 30 min → Actual: 45+ min = Upgrade to 45-min billing code
- Booked: 45 min → Actual: 60+ min = Upgrade to 60-min billing code
Example Math:
- 30-min massage rate: $75
- 60-min massage rate: $135
- Extra billable: $60
If this happens just 5 times per month, that's $300/month recovered ($3,600/year).
Solution 4: Automated Detection with Caretrics
Manual reconciliation works, but it requires daily discipline. Miss a day, and you miss revenue. Caretrics automates the entire process.
How Automated Detection Works
Every Night at 2am:
- Caretrics pulls your Jane.app Scoreboard report (all "Arrived" appointments)
- Pulls your invoices for the same date range
- Cross-references: Did every "Arrived" appointment generate an invoice?
- Flags mismatches for review
Next Morning at 8am:
- Your front desk gets an alert: "3 appointments from yesterday need billing review"
- Click through to see:
- Patient name
- Appointment date/time
- Provider(s) seen
- Services documented in notes
- Missing from invoice: [Massage therapy - $75]
Action Required: 2 minutes to review and update invoices
Average Results:
- Week 1: Recover $1,200-$2,400 (backlog cleanup)
- Ongoing: Catch 94% of unbilled services before 24 hours
- Time saved: 45 min/week vs manual reconciliation
See how automated detection works →
Real Clinic Example: How One Practice Recovered $1,275/Month
Clinic Profile:
- Multi-disciplinary (chiropractic + massage therapy)
- 420 appointments/month
- Using Jane.app for 3 years
- Problem discovered: 34% of chiro→massage handoffs were unbilled
What They Did
Week 1: Ran baseline audit (using checklist from this guide)
- Found 23 unbilled services in past 30 days
- Total value: $1,840
- Sent corrected invoices to patients (87% paid without issue)
Week 2: Implemented Service Addition Form
- Printed laminated forms on clipboards
- Trained all practitioners on handoff protocol
- Set up "Multi-Provider" appointment tag in Jane
Week 3-4: Added daily reconciliation checklist
- Front desk runs 10-minute end-of-day review
- Flags 2-5 appointments per day for review
- Resolves next morning (5 min)
Month 2: Signed up for Caretrics automated detection
- Wanted to maintain improvements without relying on manual discipline
- Automated system catches 94% vs 85% with manual checklist
Results After 90 Days
- Before: 80 unbilled appointments/month ($7,600/month leak)
- After: 4-5 unbilled appointments/month ($475/month leak)
- Monthly Recovery: $7,125
- Annual Recovery: $85,500
ROI on Caretrics: 5.8x (subscription cost $499/month, monthly recovery $7,125)
Common Mistakes (And How to Avoid Them)
Mistake 1: Only Auditing Weekly or Monthly
Why It's a Problem: Memory fades. After 7 days, practitioners can't remember which add-on services were provided. Adjusting invoices becomes guesswork.
Fix: Daily reconciliation (even if only 10 minutes). Fresh memory = accurate billing.
Mistake 2: Blaming Staff for "Forgetting"
Why It's a Problem: Unbilled services aren't a training issue—they're a process issue. Shaming staff doesn't fix the underlying problem.
Fix: Acknowledge it's a systemic issue and implement documented workflows (like the Service Addition Form).
Mistake 3: Not Following Up on Flagged Appointments
Why It's a Problem: You identify the unbilled service, but nobody updates the invoice. The gap remains.
Fix: Assign ownership. "Front desk will follow up on all flagged appointments before 10am the next day."
Mistake 4: Assuming Jane.app Will Prevent This
Why It's a Problem: Jane is a practice management system, not a revenue optimization system. It can't know if a service documented in notes should be on the invoice.
Fix: Use Jane for what it's great at (scheduling, notes, invoicing). Use automation (Caretrics) or manual workflows for revenue leak detection.
Your 30-Day Action Plan
Week 1: Baseline & Awareness
- [ ] Run the audit from this guide (calculate your unbilled services leak)
- [ ] Share findings with team (no blame, just awareness)
- [ ] Identify your #1 leak scenario (multi-provider? time extensions? add-ons?)
Week 2: Implement Daily Checklist
- [ ] Assign front desk ownership of 10-minute daily reconciliation
- [ ] Create checklist (physical or digital)
- [ ] Run checklist every day for 5 days straight
- [ ] Measure: How many unbilled services did you catch?
Week 3: Add Protocols for High-Risk Scenarios
- [ ] If multi-provider issue → Implement Service Addition Form
- [ ] If time extension issue → Add duration check at checkout
- [ ] If add-on issue → Update checkout script to ask about additional services
Week 4: Measure & Optimize
- [ ] Re-run the audit (same process as Week 1)
- [ ] Calculate improvement: Unbilled rate Week 1 vs Week 4
- [ ] Decide: Can you maintain this manually, or do you need automation?
Expected Improvement: Most clinics reduce unbilled services by 60-80% in 30 days with disciplined execution of these workflows.
Final Thoughts: $45,600/Year Is Worth Fixing
If you take nothing else from this guide, remember this:
Unbilled services aren't small potatoes. For a typical 350-appointment/month clinic, the annual leak is $45,600. That's:
- A full-time salary for an additional front desk person
- A down payment on new equipment
- 6 months of operating cash reserves
- Or simply: profit that should've been in your bank account
The good news? This leak is 100% fixable. You don't need more patients. You don't need to raise prices. You just need to bill for every service you actually provide.
Start with the daily reconciliation checklist. Implement the Service Addition Form if you're multi-disciplinary. And if manual workflows aren't sustainable (most clinics find they're not), automate it.
This guide is part of Caretrics' Revenue Optimization Library. Get more Jane.app-specific guides at caretrics.com/library.
