When a CFO, owner or regional finance leader looks at a skilled nursing building's accounts receivable, the same handful of questions tends to come up. If the business office can answer them quickly and consistently, conversations become calmer and decisions happen sooner.
Here is a practical question-and-answer guide, with the report that best answers each.
Q1: How much is owed to us, and how old is it?
Report: aging by payer and bucket. This is the foundation. It shows total balances grouped by how long they have been outstanding, split by payer. Include the previous month's view alongside so changes stand out.
Q2: Is it getting better or worse?
Report: aging trend. Chart the share of A/R in each age bucket over several months. A growing share in older buckets is an early warning, while a shrinking one signals improvement.
Q3: Where are the problems concentrated?
Report: top accounts and top payers. List the largest and oldest balances, with owners and next steps. Often a small number of accounts drive much of the older balance, and the response is targeted work.
Q4: How fast are we billing?
Report: claim submission lag. Track the days between the end of the service period or discharge and the claim being submitted. Slow billing delays everything downstream.
Q5: Why are claims being denied or delayed?
Report: denials by reason and payer. Group denials into categories and look at the largest. Include time to resolve and outcome, so the discussion covers both causes and effort.
Q6: How much cash did we collect, and when?
Report: collections against billing. Compare collections with billed amounts over time, and note timing patterns. This links A/R to cash flow and helps with planning.
Q7: What is sitting in Medicaid pending or other slow categories?
Report: pending accounts list with exposure. Show each pending account, its status, age, next step and associated balance. Leadership can then understand the size of the issue and the work involved.
Q8: How does A/R relate to census and revenue?
Report: days in A/R or a similar ratio, with census. Different organizations define this somewhat differently, so agree on the definition and keep it consistent. Pair with census and revenue to give context.
Q9: Are write-offs under control?
Report: write-offs by reason and payer. Track amounts and reasons over time, and review for patterns that suggest process fixes.
Q10: What are we doing about it?
Report: action log. A simple list of actions, owners and dates, reviewed monthly. This closes the loop between data and work.
Making the reports usable
- Standardize definitions. If two buildings calculate "days in A/R" differently, comparisons mislead.
- Use the same format each month. Familiar layouts make changes easy to see.
- Add brief commentary. A few sentences from the business office manager about what changed and why add valuable context.
- Include a data date. Make clear when the information was last updated.
- Keep it short. A one- or two-page summary with drill-down detail available will be used more than a long report.
Connect finance to operations
Many A/R issues start outside the business office. Late MDS completion, incomplete admission information and documentation gaps all influence billing. Consider including operational indicators, such as assessment timeliness and admission paperwork completeness, in the finance review so that causes get attention.
A hypothetical example
Imagine a hypothetical regional CFO who notices that aging is rising in one building. The aging trend and top-accounts list show that a few accounts tied to one payer account for most of the increase, and the denial report points to a recurring authorization issue. Rather than a broad directive, the CFO and business office manager agree on a targeted fix and a date to review. Clear reports made a focused conversation possible.
A note on tone
Finance questions can feel like pressure on the business office. Approach them as shared problem solving. The office usually knows where the obstacles are and appreciates support in removing them.
Review rhythm
- Weekly: top accounts and pending list
- Monthly: aging trend, denials, collections and action log
- Quarterly: definitions, targets and process improvements
Where CarePulse fits
CarePulse can assemble these reports from your billing, census and MDS data into a consistent monthly view for finance leaders and business offices. If you would like to see how that would look with your own numbers, a demo is a good place to start.