Accounts Receivable and Collections
Managing what is owed
Accounts receivable (A/R) is money owed to the organization by payers and patients. Key metrics: days in A/R, A/R aging (0–30, 31–60, 61–90, 90+), net collection rate, denial rate, and bad debt. Understand the difference between payer A/R and patient A/R, and the tools: follow-up worklists, claim status inquiries, payment posting, refund processing, and collection agency referral after internal efforts fail.
Patient collections require clear financial policy, point-of-service collection, payment plans, and financial assistance/sliding fee programs. Compliance matters: Fair Debt Collection Practices Act (FDCPA) and charity care rules constrain aggressive collection. Understand contractual adjustments and write-offs and when each applies.
Traps in questions
- Using gross collection rate instead of net to judge performance.
- Aggressive collection tactics that violate FDCPA or charity-care obligations.
- Writing off balances that should be pursued, or pursuing balances that should be adjusted per contract.
- Ignoring aging: a low overall A/R days figure can hide a large 90+ bucket.
Rule of thumb
Segment A/R by payer and age, work the oldest and highest-dollar first, and apply contractual adjustments per contract - not as a convenience write-off.
Worked example
A 120-day-old patient balance: verify insurance adjudication is complete, confirm the balance is truly patient responsibility, then follow the financial policy (statements, payment plan, or agency) before any write-off.