Accounts receivable is the money your building has earned but not yet collected. In skilled nursing, that balance is spread across Medicare, Medicare Advantage plans, Medicaid, managed care, private pay and other sources, and each moves at its own pace. The tool most business offices use to make sense of it is the aging report.
An aging report groups open balances into time buckets based on how long they have been outstanding. It is simple, and it is one of the most useful pages in your financial package when you read it well.
What the buckets mean
Most reports show buckets like these:
- Current to 30 days: newly billed claims still inside normal processing time
- 31 to 60 days: claims that should usually be resolving, and may need a status check
- 61 to 90 days: claims likely stuck on something, such as a missing document, a denial or an authorization question
- 91 days and beyond: balances that need a specific plan, because the chance of resolving them generally falls as they age
The exact cutoffs vary by organization. What matters is that everyone looks at the same ones.
Read by payer, not just in total
A single total hides the story. A balance that looks fine overall may be hiding one payer that is quietly slipping. Split the aging by payer class and ask:
- Which payer holds the largest share of the older buckets?
- Is that share growing or shrinking compared with last month?
- Is the issue concentrated in a few residents or spread across many?
If one payer's older balances are driven by a handful of accounts, the work is account-level follow-up. If they are spread across many accounts, the cause is more likely a process, such as a recurring billing error or a delayed submission.
Watch the trend, not the snapshot
One month of aging is a photograph. Several months is a film. Plot the share of balance in each bucket over time. A healthy pattern generally shows most dollars in the early buckets and a steady flow out of the later ones. A rising share in the 61-plus buckets is an early warning worth discussing before it appears as write-offs.
Build a bucket-by-bucket routine
Turn each bucket into a standing task:
Current to 30 days
Confirm claims were submitted cleanly and on time. Track submission lag, the days between discharge or month-end and the claim going out.
31 to 60 days
Check claim status. A short list of accounts with no response is a natural weekly task.
61 to 90 days
Look for the reason. Is it a denial, a missing authorization, or an eligibility change? Categorize and assign an owner.
91 days and beyond
Review as a group, weekly or biweekly, with a person from administration present. Decide which accounts need escalation and which need a formal decision.
Questions to bring to the meeting
- Which five accounts account for most of the oldest balance?
- Are any of the delays traced back to a front-end issue, like admission paperwork or payer verification?
- Did anything change in how a payer processes claims?
- What did we resolve this week, and what moved to the next bucket?
Connect A/R to operations
Aging problems often start upstream. Incomplete admission information, late MDS completion or unclear documentation can all slow a claim. When business office leaders can show administrators a pattern, such as one referral source whose admissions repeatedly lack payer details, the fix often belongs to the front door rather than to billing.
Where CarePulse fits
CarePulse can bring aging data together with census and MDS information so you can see by payer and by facility where balances are building and why. If you would like to see how your own aging looks as a trend, we are glad to walk through it in a demo.