Month-end can be a stressful stretch for a business office. Billing deadlines, census reconciliations, payer postings and reporting requests all converge. Offices that handle it calmly usually have one thing in common: a written, repeatable checklist that every team member understands.
Here is a practical checklist you can adapt for your building or group. It focuses on the steps that most affect A/R, revenue visibility and the numbers leaders rely on.
Before the month ends
1. Confirm census and payer status
Review the current census with admissions and nursing. Verify that payer sources are correct for each resident, including recent changes such as new coverage, ended benefit periods or pending applications.
2. Review upcoming authorization end dates
Identify authorizations expiring in the next few weeks, and confirm that extensions or reviews are underway.
3. Check assessment status
Confirm with the MDS coordinator that assessments affecting billing are complete or on schedule.
4. Review open items from last month
Make sure unresolved items did not slip through.
During close
5. Reconcile days of service
Compare billed days with census records and resident ledgers. Differences are easier to resolve when caught early.
6. Prepare and submit claims
Aim to submit clean claims promptly. Track submission date against the end of the month so you can watch submission lag over time.
7. Post payments and adjustments
Make sure recent payments are posted accurately and applied to the right accounts.
8. Review resident account balances
Check for credit balances, private-pay balances that need statements, and accounts with unusual activity.
9. Review denials and rejections
Update the denial log, assign follow-up, and look for new patterns.
After close
10. Produce the aging report
Review aging by payer and bucket. Compare with the previous month and note changes.
11. Identify the top follow-up accounts
Create a short list of the largest and oldest balances, with owners and next steps.
12. Summarize for administration
Prepare a one-page summary: revenue, A/R trend, key concerns and actions. Keep it consistent from month to month so changes stand out.
13. Capture lessons
A short note on what slowed the close this month becomes an input to next month's improvement.
Metrics to track about the close itself
The close is a process, and processes can be measured:
- Days to complete close
- Claim submission lag
- Number of corrections after submission
- Share of A/R in older buckets
- Number of open exceptions at close
Watching these over several months shows whether the process is getting smoother.
Make the checklist work
- Assign owners. Each step should have a named person and a backup.
- Set dates. Work backward from reporting deadlines.
- Use a shared tracker. A simple list everyone can see reduces missed steps.
- Hold a brief kickoff. Ten minutes at the start of the close clarifies priorities.
- Hold a brief debrief. Ten minutes at the end captures what to change.
Cross-department touchpoints
The close depends on information from other departments. Admissions, nursing, MDS and therapy all provide inputs. Sharing the checklist with them, and the dates when you need their input, builds goodwill and reduces last-minute scrambles.
A hypothetical example
Imagine a hypothetical office where the close regularly runs long because payer changes are communicated late. By adding a mid-month census and payer review with admissions, the office reduces the number of corrections during close. The checklist did not change the work, but it moved a key step earlier.
Support your team
Month-end pressure can wear on people. Cross-train where possible, avoid relying on a single person for critical steps, and recognize the effort the team puts in. A calmer close is better for accuracy and for morale.
Where CarePulse fits
CarePulse can pull billing, census and MDS data into a single view that supports the close, including aging by payer, submission lag and exception lists. If you would like to see how that might look for your office, we can arrange a demo.