Average days in AR is the number most administrators quote and the one that tells them the least. A facility sitting at 38 days feels fine. Break the same balance out by payer and the picture often changes.

Each payer ages by different rules. Medicare Part A should pay quickly and predictably, so a Part A claim that has gone 30 days without payment is almost always stuck on something fixable: a rejected edit, a missing assessment, a claim that never dropped. That is a process problem, not a collections problem. Medicaid depends on the state and on whether the resident's eligibility has actually been approved. Medicare Advantage and managed care plans pay on their own authorization and appeal timelines. Private pay behaves like consumer debt, because it is.

Blending these into one average hides the buckets that matter. Picture a 40-bed facility reporting 38 days. Medicare sits around 12, which is healthy. Private pay is at 25. Medicaid pending, a different animal altogether, carries balances four and five months old for residents whose applications are still in review. The blended figure says the facility is fine. Medicaid pending is where the cash is actually stuck. (These numbers are an illustration, not a benchmark.)

A more useful report starts by keeping Medicaid pending in its own bucket and reviewing it resident by resident, with the application date and the last contact with the county or state office printed next to each balance. Age Medicare and managed care separately, and read the oldest five claims instead of the average, because averages bury the outliers that need a person. Add a last-activity column. A balance nobody has touched in 14 days is a balance nobody owns, no matter how old it is. And compare cash collected to what you billed for the month, since that ratio moves before AR days does.

Whoever runs your revenue cycle should be able to produce this without a special request. If they can't, the reporting was built for their convenience and not yours. When you compare outsourced options, ask to see a sample AR report split by payer before you ask about price. LTCPro describes how its team approaches revenue cycle management for long term care on its service page.

Author bio: Written by the team at ltcpro.us, a US-based billing and revenue cycle partner built for skilled nursing and assisted living facilities in the 25 to 50 bed range.