Good morning.
Every administrator knows their census.
But can you tell me how much money is stuck between the care your community provided and the payment it actually received?
You already staffed the shift.
Provided the care.
Incurred the expense.
And somewhere along the way, something kept you from getting paid correctly.
An authorization didn’t cover the dates billed.
A payer change never reached the business office.
An assessment issue held up a claim.
The insurance company paid less than the contract allowed.
None of that shows up as an empty bed.
That’s why I’d spend some time looking at the occupied ones.
First, three different problems
Unbilled means the claim hasn’t gone out.
Unpaid means it went out, but payment hasn’t arrived.
Underpaid means payment arrived, but it was less than the amount properly due.
Those require different next steps.
And none automatically means the money is gone forever.
But leave them unresolved long enough, and a fixable problem can become a write-off.
A billing distinction administrators should understand
Original Medicare and Medicare Advantage are not interchangeable billing processes.
For an Original Medicare Part A skilled stay, most services are bundled into a daily payment. Providing another service doesn’t automatically create another separately billable charge.
The team needs to verify covered days, coverage requirements and an accurately supported payment classification.
For Medicare Advantage and other insurance, the team also needs to understand the specific plan’s authorization requirements and your payment terms.
“Insurance verified” is a starting point.
It doesn’t answer every question about whether this stay will be paid correctly.
Steal This: The Revenue Leakage Review
At your next financial meeting, ask your business office manager to bring five things.
1. The unbilled list—with the oldest items first.
“What care have we provided that we haven’t billed, and what specifically is holding up each claim?”
Missing documentation?
An assessment issue?
An unresolved payer question?
Ask how old the balance is and when the filing deadline hits.
A total tells you the size of the problem.
The reason tells you who can fix it.
2. The upcoming coverage and payer changes.
“For residents whose plans require authorization, which approved dates end in the next seven days? Who is requesting the next review?”
Also ask who may be approaching exhausted benefits or a payer transition.
What is the expected next payer?
What remains unconfirmed?
Coverage ending requires coordinated clinical, financial and resident communication. It does not, by itself, establish that a resident is ready for discharge.
3. The last ten denials or rejected claims.
“What happened, what can we recover, and which failures could we have prevented?”
A claim rejected before processing and a claim denied after review may need different fixes.
Don’t stop at “insurance denied it.”
Was the issue coverage, authorization, documentation, claim information or a deadline?
Who owns the correction or appeal?
4. A sample of payments compared with what was due.
“Did we receive the correct payment?”
For contracted plans, compare the payment with the applicable contract terms.
For Original Medicare, have reimbursement and billing verify the supported classification and applicable payment adjustments.
A paid claim can still be an underpaid claim.
5. Recent write-offs.
“What did we stop trying to collect—and why?”
Separate legitimate adjustments from preventable losses.
Then ask which problem has happened more than once.
Because recovering one claim is useful.
Fixing the process that keeps creating the same problem is better.
Don’t leave with “we’re working on it.”
For each material balance, leave with:
The amount at risk.
The specific obstacle.
The person responsible.
The next action.
The deadline.
And at the next meeting, check what actually moved.
One Question I’d Ask My Business Office Manager
“If we could fix one problem outside your department that would help you get claims out correctly and collect payment, what would it be?”
Then listen.
Your business office may be chasing information that admissions, nursing, MDS or another department could have supplied correctly the first time.
That’s where an administrator can help.
You don’t need to become the billing specialist.
You do need to make sure the billing specialist isn’t spending every afternoon repairing everybody else’s unfinished work.
Before you spend another hour figuring out how to fill an empty bed, make sure you’re getting paid correctly for the ones already occupied.
— Kevin
When the shift is worked—but payday is still days away
Sponsored webinar recap · In partnership with Tapcheck
A caregiver can have wages coming and still lack the money needed to get to the next shift. That was the practical problem behind our September 23 webinar with Tapcheck’s Michael Ross and CEUs.R.EZ.
Pay level and pay timing are different problems. Earned wage access addresses the second: access to part of wages already earned before the regular payday. It does not increase what someone earns.
What the room told us
These were live audience polls, not an industry-wide survey.
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59%
87 of 148 respondents said employees asking for pay before payday are told to wait.
Another 20 said it depends on who is asking.
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12%
In a separate poll, only 17 of 143 respondents said they track the full cost of replacing a CNA.
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They point to two useful questions:
- What happens when someone needs earned pay early?
- What does losing that employee actually cost us?
Michael’s most useful distinction was not simply whether a provider offers “on-demand pay.” It was how much an employee can actually access, when, and at what cost.
An employee earning $20 an hour has $200 in gross earnings after a 10-hour shift. That does not mean $200 is available to withdraw. Taxes, deductions, amounts already accessed and the provider’s calculation matter. Michael described providers that estimate availability from gross pay and others that account more precisely for expected take-home pay. Two programs with the same label can therefore produce different usable balances.
The integration matters for the same reason. If time and payroll information is incomplete or late, the balance may not reflect what the employee expects. Ask for a demonstration using your actual payroll and timekeeping setup—not just a list of supported software.
Five questions to ask any provider
- What will this cost the employer and the employee? Include setup, ongoing charges, transfer fees, the genuinely free option and fees to leave.
- How is the available balance calculated? Walk through taxes, deductions, earlier withdrawals and a corrected time entry. When does worked time become available?
- Who supplies the money—and who bears the loss if a calculation or payroll correction leaves a shortfall? Get the answer in writing.
- How will this connect to our payroll and timekeeping systems? Confirm the exact integrations, additional charges and manual work your team would still own.
- How will we judge whether it helps here? Record call-outs, attendance, retention and recruiting activity before launch. Agree on the review period and account for other staffing changes before attributing an improvement to the program.
One final point from the discussion: Michael advised against reserving access only for people who take hard-to-fill shifts. Treat the benefit and the shift incentive as separate decisions.
Watch the September 23 webinar
About Tapcheck
Tapcheck describes its reach as 3,000+ skilled nursing and senior living communities, with roughly 330 payroll and time integrations.
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