For many business offices, the last days of the month are a sprint. Reports are pulled, numbers are reconciled, questions come in from the administrator and the regional office, and everyone hopes the figures hold up. The scramble is a symptom of a process built around the deadline instead of around the month.
The alternative is to keep key A/R views current all month, so the close is a review of numbers the team already knows. This checklist walks through what to put in place.
Before the month begins
Agree on definitions
Write down how each metric is calculated: days in A/R, aging buckets, collections, adjustments, denials. Different people calculating the same metric differently is a common source of month-end arguments.
Set the report package
Decide which reports make up the standard package and in what order. A typical set might include an aging summary by payer, a list of accounts above a set age, collections versus billing, denial summary and unbilled or pending claims. Keep it consistent so changes are easy to spot.
Assign owners
Each report and each reconciliation step should have a named owner and a backup.
During the month
Review weekly
A short weekly review of aging, collections and pending items prevents surprises. It also spreads the work of correcting issues across the month.
Track unbilled and pending claims
Items waiting on documentation, authorization or a clinical sign-off do not become cash until resolved. Keep a list with ages and owners, and review it with the relevant departments.
Monitor payer-specific issues
Watch for payment delays or denials from specific payers as they appear, not at month-end. Early notes help pinpoint causes.
Reconcile as you go
Reconcile cash postings, adjustments and write-offs periodically rather than all at once. Small discrepancies are easier to investigate when they are fresh.
In the final days
- Confirm that billing is complete for the period, and identify items still pending with reasons.
- Verify cash postings against bank deposits and remittances.
- Review adjustments and write-offs for appropriateness and documentation, following your policies and approvals.
- Refresh the aging report and compare with the prior month and with the prior weeks.
- Investigate unusual movements in any payer or bucket.
- Prepare a brief narrative explaining major changes.
The narrative matters
Numbers invite questions. A short written summary, even a few bullet points, addresses the most likely ones: what changed, why, and what is being done. Include the top accounts or issues, any one-time events and actions for next month. Leaders appreciate a report that anticipates their questions.
A hypothetical example of such a summary might note that the over-90 balance rose because of one plan's delayed authorizations, that the team has identified the cause and set up a weekly follow-up, and that it expects the balance to decline over the next two months.
Hold a post-close review
After the close, spend fifteen minutes on what went well and what was hard. Were there late reports, disputed numbers or unexpected adjustments? Capture one improvement for next month. Over time, these small fixes shrink the close.
Share the results
Provide the administrator and, where relevant, regional leadership with the standard package and the narrative on a predictable schedule. Predictability builds trust and reduces ad hoc requests.
Use technology to take over the repetitive work
Much of the month-end effort is moving data between systems and rebuilding the same reports. Automating data collection and keeping dashboards current throughout the month saves time and reduces errors. The business office can then spend more time on follow-up, where human judgment matters most.
Guard against pitfalls
- Late data: If upstream data is delayed, document why and fix the source.
- Manual copy and paste: Each manual step is a chance for error.
- Undocumented adjustments: Keep clear records.
- Key-person risk: Ensure someone else can run the reports.
Control and compliance
Reporting and reconciliation procedures should align with your organization's internal controls and accounting practices. This checklist is operational guidance, not a replacement for your accounting policies or your auditors' advice.
Where CarePulse fits
CarePulse keeps A/R dashboards current throughout the month, with aging, denial and collection views organized by payer. If you would like to see how that could simplify your close, a demo with your own data is a good first step.