"We pinpointed $67,000 in missed billing codes in our first month. The ROI was immediate."
Rob spent years inside Canada's largest dental service organizations watching clinics leave millions on the table through preventable revenue leaks. After advising 50+ clinic owners and participating in multiple M&A processes, he saw the same patterns repeat across dental, physio, chiro, massage, and acupuncture practices. He built Caretrics to automate what clinic owners were doing manually—and now co-owns Human 2.0 wellness clinic in Ottawa, where he tests everything firsthand.
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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.
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.
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:
Result: $75-$95 massage service unbilled
Frequency in Multi-Disciplinary Clinics: 34% of same-day multi-provider visits have this issue
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:
Result: Under-billed by $30-$40 (depending on clinic's time-based pricing)
Frequency: 19% of appointments run longer than booked time
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:
Result: $25-$45 add-on service unbilled
Frequency: 18% of appointments have undocumented add-on services
Let's calculate your specific unbilled services leak:
Step 1: Pull your Scoreboard report (Reports > Appointments > Scoreboard)
Step 2: Pull your Payments report (Reports > Accounting > Payments)
Step 3: Calculate the gap
Step 4: Estimate monthly leak
Step 5: Annualize it
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.
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.
Timing: Last 10 minutes before closing
Responsible: Front desk or billing coordinator
Process:
Reports > Appointments > Scoreboard
Date: Today
Filter: Status = "Arrived"
Export to CSV (optional)
Result: List of every patient who showed up today
For each "Arrived" appointment:
When you find a mismatch:
See how much revenue your clinic is leaving on the table
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Expected Results:
If you run a multi-disciplinary clinic (chiro + massage, physio + naturopathy, etc.), you need a documented handoff protocol for same-day multi-provider visits.
When to Use: Any time a patient will see multiple practitioners in one visit (planned or unplanned)
How It Works:
Before patient leaves first treatment room:
When notified:
After completing treatment:
At checkout:
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: __________
Catch time-based under-billing before patient checks out.
Settings > Appointments > Track Actual Duration
When enabled, Jane tracks when appointments actually start and end (based on clinical note creation/completion times).
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:
Example Math:
If this happens just 5 times per month, that's $300/month recovered ($3,600/year).
Manual reconciliation works, but it requires daily discipline. Miss a day, and you miss revenue. Caretrics automates the entire process.
Every Night at 2am:
Next Morning at 8am:
Action Required: 2 minutes to review and update invoices
Average Results:
See how automated detection works →
Clinic Profile:
Week 1: Ran baseline audit (using checklist from this guide)
Week 2: Implemented Service Addition Form
Week 3-4: Added daily reconciliation checklist
Month 2: Signed up for Caretrics automated detection
ROI on Caretrics: 5.8x (subscription cost $499/month, monthly recovery $7,125)
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.
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).
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."
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.
Expected Improvement: Most clinics reduce unbilled services by 60-80% in 30 days with disciplined execution of these workflows.
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:
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.