Aging A/R Cleanup for Skilled Nursing Facilities
Your staff cannot clean up the past and stay current at the same time. We take the aged buckets so they can keep this month's billing on schedule.
How Aged A/R Actually Accumulates
It is rarely one failure. A business office manager leaves. A software conversion eats three weeks. A payer changes its authorization rules. Any one of those is survivable — but current billing never pauses while you recover, so the backlog does not get worked, it gets older.
Aged balances then become self-reinforcing. The staff who could work them are consumed by this month's claims. The accounts that need the most research are the ones nobody has time to research. Timely filing windows close without a notification. Appeal rights lapse.
Eventually the conversation stops being about collection and becomes about how much to write off — usually without a clear basis for deciding which balances were genuinely uncollectible and which were simply never worked.
What Our Aging A/R Cleanup Includes
We start with an honest analysis of what you have, then work it in priority order and tell you what we find.
- Full aging analysis — by payer, by bucket, and by resident, so you can see where the money actually is
- Triage and prioritization — every balance sorted into collectible now, needs documentation, needs appeal, or genuinely uncollectible
- Claim correction and rebilling — claims fixed and resubmitted while timely filing windows are still open
- Denial research and appeals — denials worked to root cause and appealed with supporting documentation
- Payer follow-up and escalation — persistent follow-up on claims sitting in payer queues, with escalation when calls stop working
- Medicaid-pending resolution — pending applications tracked and retroactive eligibility billed once approved
- Credit balance and unapplied cash review — overpayments and misapplied payments identified and corrected
- Private pay and responsible party follow-up — handled professionally, with the resident relationship in mind
- Documented write-off recommendations — with the reason, so your write-offs have a defensible basis
- Transparent reporting — regular updates showing what moved, what did not, and why
Payers and Balance Types We Work
Aged A/R is never one payer. We work the whole aging, not just the easy columns.
| Payer or Balance Type | What We Cover |
|---|---|
| Medicare Part A and Part B | Rebilling, denial appeals, ADR responses, and claims stalled in processing |
| Medicaid and Medicaid pending | Application follow-up, retroactive eligibility billing, and state-specific requirements |
| Managed care and Medicare Advantage | Authorization disputes, level-of-care denials, and underpayment review |
| Private pay and responsible party | Statements, follow-up, and payment arrangements handled professionally |
| Hospice and VA | Coordination-of-benefit balances and contract billing |
| Credit balances | Overpayment identification, refunds, and unapplied cash correction |
What Makes NHBS Different
What Changes When This Is Handled Properly
We will not put a recovery percentage on this page, because the honest answer depends entirely on the age and payer mix of your aging. What we can promise is the shape of the result:
You know what you actually have
An aging that has been triaged tells you which balances are real receivables and which are already losses. Most facilities have never had that distinction made.
Current billing stays current
Because we take the backlog, your business office is not choosing between this month and last year.
Write-offs become defensible
Every recommended write-off comes with the reason it could not be collected, which matters at audit and at year end.
Aging A/R Cleanup FAQs
Do we have to hand over our entire A/R?
No, and most facilities do not. It is common to assign a portion — everything over 90 days, or one payer, or a specific date range — while your staff keeps current billing moving. That split is usually the whole point of bringing us in.
How much aged A/R is too much?
It depends on your payer mix, but the more useful question is how much of your aging has actually been worked. A facility with a high 120+ bucket that is being actively researched is in a different position than one where nobody has touched those accounts in six months.
If you are not sure, send us the aging and we will tell you what we see.
Is anything too old to collect?
Some of it, yes. Timely filing windows and appeal rights do expire, and they vary by payer and state. Part of the first pass is identifying what is out of time so nobody spends hours on balances that cannot be recovered — and, more importantly, catching what is about to expire but has not yet.
Will you work inside our software?
Yes. We work in the system you already use rather than asking you to migrate data. We routinely work in the billing and clinical platforms common to skilled nursing.
What do we actually receive at the end?
Cash collected, a triaged aging you can act on, documented write-off recommendations with reasons, and reporting throughout showing what moved. Several clients have told us the reporting was as valuable as the collections.
How is this priced?
Engagements are scoped after we look at your aging, because the work involved in a 90-day managed care bucket is very different from a two-year Medicaid-pending backlog. The analysis itself is free and comes with no obligation.
Start With a Free A/R Analysis
Send us an aging report. We will tell you what we think is recoverable before you commit to anything.