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Month-End Close Checklist for Facility A/R Review

A consistent month-end A/R review keeps small issues from becoming write-offs. Use this checklist to organize the talk between administrators and billing.

3 min readBy CarePulse Analytics Team

Month-end is when finance teams close the books, and it is also a natural moment for a focused review of accounts receivable. Done consistently, a short, structured review catches problems while they are still easy to fix. Done inconsistently, issues pile up until they become write-offs.

This checklist is designed for the conversation between an administrator, business office manager and, where applicable, regional finance leaders. Adapt it to your own systems and processes.

Before the Meeting

  1. Confirm that the data is current. Make sure the aging report reflects the close date.
  2. Reconcile key totals. Compare the A/R balance in your reporting with the general ledger or source system.
  3. Prepare the aging by payer and by age bucket.
  4. Pull the largest balances and the oldest balances.
  5. Prepare a list of denials and their status.
  6. Gather comparisons with the prior month and the same month in the previous period if available.

During the Meeting

Step 1: Review the Overall Picture

  • What is the total A/R, and how does it compare with last month?
  • How has the distribution across age buckets shifted?
  • How do days in A/R look, using your agreed definition?

Step 2: Review by Payer

  • Which payers hold the largest balances?
  • Which payers have the largest older balances?
  • Are there new patterns, such as a payer slowing down?

Step 3: Review the Largest and Oldest Items

For each of the top items, confirm:

  1. What is the status?
  2. What is the next action?
  3. Who owns it?
  4. When will it be reviewed again?

Step 4: Review Denials and Rework

  • What were the top denial reasons this month?
  • How many were resolved and how many remain?
  • Which upstream processes contributed?

Step 5: Review Billing Timeliness

  • Were claims submitted on schedule?
  • Are any assessments, authorizations or documents holding up billing?
  • Are there accounts that have not been billed and should have been?

Step 6: Check Private Pay and Other Balances

  • Are private pay balances being followed up consistently?
  • Are there accounts approaching points where earlier conversations with families would help?
  • Are any balances awaiting eligibility determinations?

After the Meeting

  1. Document the action list with owners and dates.
  2. Share results with the department heads whose processes affect A/R.
  3. Update any checklists or procedures based on lessons learned.
  4. Schedule follow-up for the highest priority items.

Measures to Carry Forward

Track a small set of measures over time:

  • Total A/R and its distribution by age.
  • Days in A/R.
  • Denial rate and top reasons.
  • Time from service to billing.
  • Collections compared with billing.
  • Write-offs, with reasons.

A Hypothetical Example

Picture a hypothetical building where the month-end review consistently surfaces a handful of large balances that were waiting on documentation. The team adds a mid-month checkpoint to chase those items earlier. At the next month-end review, fewer of them appear in the older buckets, and the conversation turns to different issues.

Keep the Tone Collaborative

The business office often carries blame for A/R outcomes that depend on many departments. Use the review to identify where support is needed. Ask what would make their work easier and follow through on requests.

Multi-Building Considerations

For groups, consistency matters. Use the same checklist and definitions in every building so results can be compared. A regional view can also highlight where practices at one building might help others.

Keep Compliance in View

Questions about billing rules, write-off policies and documentation requirements belong with your compliance and finance professionals. The checklist helps you organize the conversation, not replace their expertise.

Making It a Habit

  • Schedule the meeting on the same day each month.
  • Keep it to an hour or less.
  • Use the same report format every time.
  • Track whether action items get completed.

See It Prepared for You

CarePulse Analytics assembles aging, denial and billing timeliness data so your month-end review starts with a ready-made picture. If you would like to see it using your own numbers, a demo is a good place to begin.

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