Medicare and Medicaid get most of the attention in A/R discussions, but for many buildings the accounts that age quietly are private pay and managed care. They follow different rules, involve different conversations and need their own tracking. Left to general workflows, they tend to slip.
This post covers what to track for each, and how to organize follow-up so the right person acts at the right time.
Managed care: the authorization lifecycle
Managed care plans typically require authorizations for admission and continued stay, with set periods and required clinical updates. The details vary by plan and contract, so your team's knowledge of each plan matters. What analytics can add is visibility across the lifecycle.
What to track
- Authorization requested: date and responsible person
- Authorization received: date, covered days and any conditions
- Expiration dates: with advance alerts
- Continued-stay review deadlines: when updates are due
- Status of pending requests, including how long they have been waiting
- Denials or reductions, with reasons and appeal status
Helpful views
A calendar of expiring authorizations for the next two weeks, sorted by date, is one of the most practical tools in the business office. A second list showing requests pending beyond a set number of days prompts follow-up. A third summarizing denial reasons by plan reveals patterns.
Cross-department connection
Authorization work depends on timely clinical information from nursing and therapy. Dashboards that make the status visible to those teams help them provide what is needed on time.
Private pay: communication and consistency
Private pay accounts involve families and residents directly. Delays here are often about communication, not process.
What to track
- Billing sent: date and method
- Payments received versus expected
- Aging by account, with notes on contacts made
- Payment method and autopay adoption
- Pending benefits applications, where a resident may transition to another source of payment
- Deposits, adjustments and refunds, tracked carefully
Helpful views
A work list sorted by age and balance, with the date of the last contact and the next planned step, keeps outreach consistent. A view of expected payer transitions, such as an application pending for a benefit, helps plan.
Compassionate, clear follow-up
Families dealing with a loved one's care are often under stress. Early, clear and respectful communication reduces misunderstandings. Standard scripts, regular statements and a named point of contact help. Data cues the outreach; people provide the relationship.
Shared principles for both
- Assign every account an owner and a next action.
- Set follow-up cadences, for instance weekly for accounts above a certain age.
- Document every contact so anyone can pick up the thread.
- Review by payer or plan to spot systemic issues.
- Escalate when an account passes defined thresholds.
A hypothetical example
Imagine a hypothetical building where a handful of private pay accounts have aged past 60 days. The work list reveals that for most, the last contact was a statement mailed weeks ago. The business office sets a rhythm of phone outreach at a specific age, adds a payment plan option within policy and logs each contact. Over the following months the older balances shrink and relationships stay positive.
Metrics to review monthly
- Aging by payer class, with managed care and private pay shown separately
- Share of authorizations with no gaps in coverage
- Average days from request to approval by plan
- Denials by reason and plan
- Private pay aging and contact coverage
Policies and compliance
Billing, collections and refund practices must follow applicable laws, contracts and your organization's policies. Analytics does not replace those rules; it helps your team follow them consistently. Consult your compliance and legal advisors where needed.
Learn from patterns
If one plan consistently takes longer to approve, build that into your admission planning. If private pay balances tend to rise when billing goes out late, adjust the calendar. The patterns in your data are usually the most reliable guide to where to improve.
Where CarePulse fits
CarePulse can organize authorization status and private pay aging into work lists and dashboards by plan and account. If you would like to see your own authorization and private pay views, we would be happy to set up a demo.