The final weeks of the year bring a particular kind of pressure to long-term care finance teams. Holidays shorten the working calendar. Payers and vendors operate on adjusted schedules. Budgets, audits and next year's plans are all on the table. Meanwhile, receivables keep aging.
A structured year-end review can help ensure that cash flow stays steady and that you begin the new year with clean books and clear priorities. This checklist is meant for a business office manager, administrator or CFO. It is a general guide, so adapt it to your organization and accounting practices.
1. Review the aging report by payer
Look at all buckets, by payer class, and compare with the prior month and the same time last year. Identify the largest older balances and categorize them as slow, stuck or at risk. Assign an owner and date to each of the largest items.
2. Confirm everything billable has been billed
Check that all eligible days and services through the most recent period have been billed. Compare census records with billing records to find days that never made it onto a claim. Unbilled items are the simplest receivable to recover.
3. Work denials and appeals with deadlines in mind
Review open denials and any appeals approaching their filing deadlines. Prioritize by dollar amount and by likelihood of success. Make a calendar of deadlines, since missed windows can end the opportunity.
4. Reconcile payments and adjustments
Verify that payments received have been posted correctly and that adjustments are valid and documented. Look for unapplied cash and underpayments relative to expected amounts.
5. Review authorization and eligibility records
Confirm that current residents' payer information is accurate, and that authorizations covering the coming weeks are in place. Year-end often coincides with plan changes, so verify coverage for residents whose plans may renew.
6. Check private pay and family balances
Review private pay statements and follow-up. Reach out with kindness and clarity. Offer payment arrangements where appropriate and document them. Holidays can be a stressful time for families, so thoughtful communication matters.
7. Evaluate allowances and write-off policies
Work with your finance leadership to review whether reserves and write-off decisions reflect current realities. Follow your organization's policies and consult your accountants as appropriate.
8. Plan for the holiday calendar
Identify payer remittance and bank processing schedules around holidays so you know when to expect cash. Arrange coverage in the business office so claims and follow-up continue during staff vacations.
9. Measure the metrics that matter
Capture key numbers at year-end so you can compare in future periods:
- Days in A/R, overall and by payer.
- Cash collected versus billed, by month.
- Denial rate and top denial reasons.
- Days from service period end to billing.
- Percentage of balances over 90 days.
10. Capture lessons for next year
Sit with the team and ask: what slowed us down this year? Which payers were hardest to work with? Which process fixes helped most? Document a short list of improvements to begin the new year with, and assign owners.
Make it a team effort
Cash flow is not only the business office's concern. Admissions, MDS, nursing and therapy all affect billing through documentation and timeliness. Share the year-end picture with them, and thank them for what went well. A little recognition goes a long way, particularly at a busy time of year.
A hypothetical example
Imagine a hypothetical building that, during its year-end review, discovers a handful of days that were never billed because of a discharge record that was not updated in the billing system. Recovering those days was straightforward once found. The team then adds a weekly reconciliation of census and billing to prevent a repeat.
Where analytics helps
Most of these checks involve comparing two sources of data, such as census and billing, or authorizations and billed days. When those comparisons are automated, the checklist becomes a quick review instead of a time-consuming hunt. CarePulse Analytics builds finance dashboards from the systems operators already use. If you would like to see what a year-end view could look like with your own numbers, we can arrange a demo.