Month-end can feel like a scramble in a nursing facility business office. Claims are being finalized, payments posted, statements prepared and reports requested by multiple people. When cash is the priority, a clear month-end routine for accounts receivable helps the team avoid the rush and spot problems while they are still small.
Here is a practical routine you can adapt.
Before month-end: the last week
Confirm billing is current
- Check that all eligible claims for the month have been submitted or are scheduled.
- Review any residents with admission, discharge or payer changes during the month and confirm that billing reflects them.
- Look for stays without a first claim, which are easy to overlook.
Reconcile assessment and billing timing
- Compare assessment schedules with billing to confirm that anything affecting payment is complete.
- Follow up with the MDS team on outstanding items.
Post payments promptly
- Make sure payments received are posted before the close, so balances are accurate.
- Review unapplied or unidentified payments.
At month-end: the key reports
Generate the same set each month so comparisons are straightforward:
- A/R aging by payer.
- Days in A/R, using a consistent method.
- Cash collected versus expected, by payer.
- Denials and rejections for the month, with causes.
- Unbilled charges and the reasons.
- Pending Medicaid and private-pay balances.
Review with a purpose
Look for movement
What changed from last month? A payer whose balances aged more, a rise in denials of a certain type, or a drop in cash relative to billing all deserve a look.
Compare cash with expectations
If you can estimate expected payment from billing, compare to actual collections. A persistent gap for a payer can point to underpayments, delays or posting problems.
Identify the top accounts
List the largest or oldest balances and assign a specific next step and owner to each. A short list with owners beats a long report no one acts on.
After month-end: assign and follow
Within a few days, hold a short meeting with the business office team and administrator or controller. Review:
- The top five findings.
- Actions with owners and dates.
- Any process issues that created problems, such as a delay in admission notifications.
Record these in a shared log, and review it the following month to see what was completed.
Quarterly: step back
Every quarter, look at three-month trends and pick one improvement project. A hypothetical example might be reducing the time between discharge and final billing, or improving documentation at admission. Track a specific measure, such as the share of claims submitted within a target number of days, and report progress.
Metrics worth keeping on the front page
- Days in A/R and trend.
- Share of A/R older than your internal threshold, by payer.
- Clean claim rate.
- Cash collected versus billed.
- Denials by cause.
- Pending case aging for Medicaid and private pay.
Keep roles clear
Name who owns each report and each follow-up. When responsibilities are unclear, tasks fall between people. A simple checklist for month-end with initials and dates adds accountability and helps new staff learn the process.
Share with the wider team
Cash is not only a finance issue. Admissions, nursing and MDS all affect it. A brief summary shared with department heads helps them see how their work connects to the building's financial health.
Reduce manual work
Month-end reports assembled manually from several systems are slow and error-prone. When the business office spends days building spreadsheets, it has less time to work accounts. Automating data pulls provides more consistent numbers and frees time for follow-up.
Beware of these habits
- Waiting until month-end to look at aging.
- Reporting totals without ownership of the largest balances.
- Changing definitions between months, which makes trends meaningless.
- Skipping the review when things seem fine.
Start small
If your current process is informal, begin by writing the checklist above and running it for two months. Adjust as you learn what your building needs.
CarePulse can pull billing and EHR data into a month-end A/R view that is consistent from month to month. If you would like to see how that could look for your facility or group, we are glad to set up a demo.