The final week of the year is quiet in many buildings. Admissions slow down, schedules thin out and the business office has a rare chance to look at the whole A/R picture without the usual interruptions. It is also a natural point to reset: clear what can be cleared, document what cannot and set up the new year with cleaner books.
This checklist is meant to be practical and flexible. Adapt it to your building's policies, your payers and your accounting team's guidance.
Before you start
- Agree on goals. Decide what a successful cleanup looks like, such as a shorter list of aged items with named owners and next steps.
- Involve the right people. Business office, administrator and, where relevant, accounting or ownership.
- Pull a current aging report by payer class and by age bucket. Save it as your baseline.
The checklist
1. Review the oldest balances first
Sort by age. For each item in the oldest buckets, determine its status: pending payer response, awaiting documentation, appealed, in dispute, or unclear. Anything marked unclear needs investigation.
2. Assign an owner and next action
Every item gets a name, a next step and a date. If a balance has no clear path to resolution, flag it for a leadership decision.
3. Resubmit and follow up
Items that can be resubmitted or appealed within allowable windows should be queued now. Check filing deadlines carefully, since time limits vary by payer and situation.
4. Reconcile payments and adjustments
Confirm that received payments are applied correctly and that adjustments are documented. Unapplied cash and misapplied payments can make A/R look worse or better than it is.
5. Review credit balances
Credit balances deserve attention. Identify them, determine their cause and follow your policies and applicable requirements for resolving them.
6. Check private pay and responsible-party accounts
Review aging for private pay balances separately. Contact responsible parties with a clear, respectful statement and discuss payment options where appropriate.
7. Document write-off decisions
If a balance must be written off, follow your approval process and record the reason. Treat write-offs as reviewed decisions with an audit trail, not a default.
8. Capture reasons for delay
For the items you worked, record why they aged. Even a short list of causes will be valuable for process improvement next year.
9. Prepare the handoff
Create a summary of what remains, who owns it and what comes next. Share it with leadership so that the new year starts with a shared view.
Metrics to record
- Total A/R and share in older buckets at the start and end of the cleanup
- Number of items resolved, resubmitted and escalated
- Top reasons for delay
- Credit balances identified and resolved
These become a baseline for comparison in the first quarter.
After the cleanup
Fix a process or two
Choose one or two root causes from your list and decide what to change. It might be an earlier eligibility check, a pre-bill review or a clearer handoff from nursing documentation to billing.
Keep the weekly rhythm
A cleanup is only valuable if the weekly review continues. Put a standing meeting on the calendar for January.
Thank the team
Business office work is detailed and often unnoticed. Acknowledging the team's effort matters.
Avoid these mistakes
- Rushing write-offs. Resolve what can be resolved first.
- Skipping documentation. Notes protect you later.
- Ignoring small balances. They add up and may signal process issues.
- Doing it alone. Input from admissions, nursing and MDS helps explain causes.
A hypothetical example
Imagine a hypothetical business office manager who uses the quiet week to work through the oldest items. Along the way, she notes that many were delayed for the same reason: missing information at admission. She shares the pattern with the admissions director, and they agree on a simple intake checklist to start in January.
Where CarePulse fits
CarePulse can organize A/R by payer, age and reason, with owners and next steps, so cleanup lists are ready when you need them. If you would like to see how that would look for your building, we are happy to walk through a demo.