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Authorization and Getting Paid, lesson 4 of 4
Reading Your Own Aging Report
Production tells you what you did. Aging tells you what you were paid for, and in a practice like this the gap between those two is the whole story. Most offices look at the total. The shape is where the information is.
- Not the total. The distribution across the buckets
- Split it. By payer, by procedure, by who submitted
- The danger zone. Anything approaching a filing deadline
- Weekly. Because the windows are short
What the Report Is For
An aging report groups what you are owed by how long it has been outstanding. Its job is to answer one question, which is whether money is moving or sitting.
A healthy practice has most of what it is owed in the youngest bucket and very little in the oldest. That is true whatever the rates are, because it is a statement about the process rather than about the price.
The total is the least useful number on it. A practice with a large total that is nearly all recent is fine. A practice with a small total that is mostly old has a real problem.
Cut It Three Ways
By payer. Fee for service and each plan behave differently, and averaging them hides the one that has stopped paying.
By procedure. A single procedure sitting in the old buckets usually means an authorization or documentation problem specific to it, not a general slowness.
By who submitted it. This is not about blame. It is about finding the person who needs twenty minutes of training, which is cheaper than any other fix available.
The Bucket That Should Frighten You
Anything approaching the filing deadline is money you are about to lose rather than money you are waiting for. It should be worked before anything younger, regardless of amount.
Practices routinely work the largest balances first because that feels rational. Working the oldest first is usually worth more, because the old ones are the ones that can actually disappear.
Get the filing windows from your state program and mark the bucket that sits inside them. Then that bucket becomes the first thing anybody looks at.
Do Not Judge It Against a Private Practice Benchmark
Collection ratios and days outstanding published for private practice assume a different payer mix, a different authorization burden and patients who pay a share. None of those hold here.
Compare the practice against itself over time instead. Is the oldest bucket growing or shrinking, month on month, is the only question that means anything.
A stable oldest bucket in a growing practice is a good sign, even if the absolute number is larger than last year.
Before You Spend a Dime
How often should we run it?
Weekly to work it, monthly to read the shape. Anything less frequent and the short filing windows start doing damage before anybody sees the trend.
What is a good number?
Your own last few months. Benchmarks drawn from private practice will make a perfectly healthy program practice look broken and are not worth the anxiety.
Our total went up. Is that bad?
Not on its own. A growing practice is owed more. Look at whether the oldest bucket grew, which is the part that matters.
Next Problem to Solve
- When the Right Treatment Is Not the Covered TreatmentNext in the course. What to do on the day the plan a patient needs and the plan the program will pay for are not the same, without either misleading the patient or quietly lowering your standard.
- A Denial Is Almost Always a Document ProblemRelated. How to read a denial, sort the ones worth reworking from the ones that are telling you something, and stop the same denial from arriving again next month.
- The Numbers That Mean Something at These RatesRelated. Which practice metrics still work when the fee schedule is set by somebody else, which ones actively mislead, and the short list worth watching weekly.
- Getting Paid by Denti-Cal Without Losing a MonthRelated. How to cut denials on Medi-Cal dental claims, which ones are worth appealing, and the front desk habits that decide both.