For a CFO or finance leader in long-term care, month end is a convergence point. Census must be reconciled, billing finalized, adjustments recorded and revenue recognized. How well that process runs shapes the accuracy of financial statements and, less obviously, the health of accounts receivable in the weeks that follow.
Delays and errors at close tend to reappear later as aging balances, denials and write-offs. Treating the close and A/R as one connected process helps leaders prevent problems rather than chase them.
Use this checklist as a starting point and adapt it to your organization.
Before month end
Confirm census and payer information
- Review census records for accuracy, including admission and discharge dates.
- Check that payer designations and changes are updated.
- Verify that any payer transitions during the month are captured.
Check assessment and documentation status
- Confirm that required assessments are complete and on time.
- Identify any items pending that could hold up billing.
- Flag documentation gaps with the clinical and MDS teams early.
Review authorizations and eligibility
- Make sure authorizations are in place where needed.
- Confirm eligibility for residents with new coverage.
Early attention to these items is the cheapest way to prevent downstream problems.
At month end
Complete billing promptly
- Track the percentage of billing completed each day after the period closes.
- Identify blockers and assign owners.
- Prioritize claims that carry larger balances or time-sensitive deadlines.
Reconcile revenue and census
- Compare billed days to census records by payer.
- Investigate variances before they accumulate.
Record adjustments carefully
- Document contractual adjustments, write-offs and other entries with clear reasons.
- Ensure approvals follow your policies.
Review private-pay statements
- Confirm that statements are accurate and sent on schedule.
- Check for any recent changes to agreements or payment methods.
After the close
Analyze A/R aging
- Review aging by payer and look for movement into older buckets.
- Identify the largest and oldest balances and confirm each has an owner and next step.
- Compare days in A/R with prior months and your goals.
Review cash collected
- Compare collections to billing and to expectations.
- Investigate any unusual delays from particular payers.
Examine denials and rejections
- Group by reason and payer.
- Identify upstream causes and assign owners for prevention.
- Track time to resolution.
Assess data quality
- Note any errors discovered during the close and where they began.
- Capture them in a short log to guide process improvements.
Make the close a team effort
The close touches many roles: admissions, nursing, MDS, business office and finance. A short debrief each month, perhaps twenty minutes, can strengthen collaboration.
- What went smoothly?
- What caused delays?
- Which errors were avoidable, and where did they originate?
- What is one change to try next month?
Capturing these lessons builds a stronger process over time.
Metrics to track across months
- Days to complete billing after period end.
- Clean claim rate.
- Days in A/R and aging distribution.
- Denial rate and top reasons.
- Adjustments and write-offs by category.
- Close timeline, from period end to final numbers.
Watch trends, and note which actions led to improvements.
Support multi-facility consistency
For groups, consistency across buildings is valuable. Use a common close calendar, shared definitions and standard reports. When one building runs more smoothly than another, learn from it and spread the practice. Visibility into the close timeline across locations helps corporate finance identify where support is needed.
Communicate with operations
Finance insights are most useful when shared. Summarize key findings for administrators in plain language, such as which issues are slowing cash, which are improving and what operations teams can do to help. Operations leaders often make the changes that finance wants to see.
Protect privacy
Closing processes involve protected health information. Use role-based access, share aggregated views with leadership and apply the minimum necessary principle.
Common pitfalls
- Treating close and A/R as separate. Problems at close become aging later.
- Lacking owners. Every blocker should have a name.
- Skipping the retrospective. Without learning, errors repeat.
- Relying on manual tracking. Spreadsheets get stale and error-prone.
How CarePulse helps
CarePulse links census, assessment, billing and A/R data so finance and operations can see close progress and collections trends together. If you would like to see a close dashboard built from your own data, we are glad to schedule a demo.