If your assisted living revenue cycle feels like a leaky bucket, you are not failing. You are operating in a system built on moving parts. Private pay, Medicaid waiver services, managed care rules, frequent eligibility changes, and staffing gaps all collide in one place: your business office.
This matters because most residents pay out of pocket, and the costs are significant. KFF reports the average cost of assisted living was $64,200 in 2023. Medicare does not cover assisted living costs, while Medicaid may cover some services through HCBS and other pathways. So, every missed authorization, missed unit, or missed resident responsibility becomes a real cash delay.
Meanwhile, Medicaid is huge and heavily monitored. CMS reports Medicaid spending grew to $871.7 billion in 2023. When oversight rises, clean processes become your best defense.
This guide shows how to transform your assisted living revenue cycle in 90 days with practical steps, clear owners, and measurable KPIs. In our 20+ years supporting long term care operations, LTCPro has seen that the fastest improvements come from tightening intake, documentation, and billing controls, not from chasing AR harder.
Assisted Living Revenue Cycle in 90 Days, The Simple Model
A 90-day transformation works when you treat the revenue cycle as an operational system, not a billing department problem.
Your 90-day goal is to improve four numbers:
- Faster cash, lower AR days
- Higher cleaner claim rate
- Lower denial rate and denial dollars
- Higher collection rate for resident responsibility
We will use a three-phase plan:
- Days 1 to 30: Diagnose and stop the biggest leaks
- Days 31 to 60: Standardize and automate the core workflow
- Days 61 to 90: Optimize, scale, and lock compliance
Days 1 to 30: Diagnose and Stop the Bleeding
Build Your Baseline KPI Dashboard
Start simple. Measure weekly. Report to leadership.
Core KPIs
- AR days by payer (private pay, Medicaid waiver, managed care)
- Aging buckets (0 to 30, 31 to 60, 61 to 90, 90+)
- Clean claim rate (first pass acceptance)
- Denial rate by category (count and dollars)
- Authorization compliance (active and within limits)
- Eligibility verification compliance (monthly for all payer types)
- Resident responsibility collection rate
Deliverable by day 7
One dashboard, one page, one owner.
Fix Intake and Move In Workflow First
Most revenue problems begin on day one.
Move in revenue cycle checklist
- Accurate demographics, payer, and plan details
- Signed financial agreement and rate sheet
- Deposit and payment method captured
- Benefit verification completed and filed
- Service plan and assessed level captured
- Authorization started if waiver or managed care requires it
KFF notes most people pay assisted living costs themselves, while Medicaid may cover some services residents receive. That means your intake must clearly separate:
- Room and board responsibility
- Covered services, if any
- Non covered add ons
Quick win
Create a one page “Move In to Billing Handoff” form. Require it before any billing starts.
Tighten Resident Responsibility and Collections
Assisted living cash flow often depends on private pay collections.
30 day actions
- Standardize billing cycle dates
- Offer autopay and card on file, with consent
- Create a friendly collections script for day 5, 15, 30
- Add a financial counseling touchpoint at move in
- Create a clear refund policy and timing
Anonymized scenario
A community had strong occupancy but poor cash timing. They billed irregularly and rarely used autopay. In 30 days, they standardized statement timing and moved 60 percent of residents to autopay. AR improved without adding staff.
Stop Denials by Fixing the Top 3 Causes
Do not fix everything. Fix what repeats.
Denial categories to track
- Eligibility and enrollment
- Authorization expired or units exceeded
- Documentation mismatch
- Coding and modifiers
- Timely filing and missing attachments
- Provider identifiers and enrollment gaps
Documentation and information gaps are common payment failure points across programs, so focus on proof and completeness early.
Deliverable by day 30
A top 3 denial report with prevention steps, owners, and due dates.
Days 31 to 60: Standardize the Core Workflow
Create a Clean Claim Gate for Waiver and Insurance Billing
If your team submits “maybe claims,” your payer will respond with “no.”
Clean claim gate, five checks
- Eligibility verified for dates of service
- Correct payer path confirmed (FFS vs MCO, correct plan)
- Authorization active and within limits
- Documentation present and matches services delivered
- Provider identifiers correct (NPI, taxonomy, enrollment)
Make it operational
- No gate, no submission
- Build it into your billing tracker or billing software workflow
Standardize Service Documentation So It Matches Billing
Assisted living often includes a mix of:
- Room and board
- Care level packages
- HCBS waiver services (for some residents)
- Ancillary services and add Ons
Documentation must answer
- What service was delivered
- When and by whom
- Units and duration, if required
- Link to the service plan or care plan
Templates to standardize by day 60
- Personal care support note template
- Medication assistance note template (if billed or tracked)
- Nurse visits note template
- Transportation or special service note template
- Incident and change of condition note template (helps support level changes)
Authorization and Units Management, Put It on Rails
Authorization failures are preventable if you manage them like inventory.
Build an authorization tracker
- Start date, end date
- Authorized units by code
- Remaining units
- Alerts at 14 days to expiry
- Alerts at 80 percent and 95 percent usage
- One owner per resident, not a shared inbox
Anonymized scenario
A community billed waiver personal care but did not track unit consumption. Denials rose for “units exceeded.” After adding a unit tracker that schedulers could see, denials fell because visits were adjusted before billing.
Tighten Provider Enrollment and Revalidation Compliance
Enrollment gaps can block payment even when care is perfect.
Federal regulation requires state Medicaid agencies to revalidate provider enrollment at least every five years.
Day 31 to 60 controls
- Create a central provider file
- Track licenses and renewals
- Track revalidation dates
- Track managed care contracting status
- Establish a change control process for ownership or location changes
Make Staffing Reality Part of the Plan
Process design must reflect staffing constraints.
AHCA and NCAL report 493,604 total employees in the assisted living profession as of September 2024. This scale plus turnover pressures means your workflow needs clarity and simplicity.
Operational choices that help
- Reduce handoffs
- Use checklists
- Define ownership by role
- Keep documentation templates short and consistent
- Automate reminders for eligibility and authorizations
Days 61 to 90: Optimize, Scale, and Lock Results
Payment Posting and Underpayment Detection
Denials are visible. Underpayments are quiet. Both hurt.
90-day reconciliation controls
- Post remittances consistently
- Compare expected vs paid by resident and date span
- Log adjustments and recoupments
- Appeal underpayments when allowed
- Track average days from service to cash
Deliverable
A weekly underpayment and adjustment report.
Rate and Package Governance
Assisted living revenue often depends on pricing accuracy and consistency.
90-day governance checklist
- Confirm package definitions match documentation and billing
- Confirm rate tables match signed agreements
- Confirm add ons have clear start and stop dates
- Confirm level changes have documented triggers and approvals
Anonymized scenario
A community upgraded resident care levels but delayed updating the billing package. They lost revenue without realizing it. Fix was a level change workflow that required billing update within 48 hours.
Create a 90 Day Playbook That Survives Turnover
If your improvements depend on one person, they will vanish.
Build a revenue cycle playbook
- Move in checklist
- Eligibility verification schedule
- Authorization tracking workflow
- Documentation templates and minimum standards
- Clean claim gate rules
- Denial triage rules
- Monthly KPI cadence and meeting agenda
In working with facilities nationwide, LTCPro has found that this single playbook is often the difference between “short term improvement” and “permanent lift.”
FAQ
How do you improve an assisted living revenue cycle fast?
Standardize intake, confirm payer and benefits early, tighten authorization and unit tracking, use a clean claim gate, and run weekly KPI reviews.
What should a 90 day revenue cycle plan include?
Baseline KPIs, move in workflow fixes, collections improvements, clean claim edits, denial prevention, and payment reconciliation.
Does Medicare pay for assisted living?
KFF notes Medicare does not cover assisted living costs, while Medicaid may cover some services residents receive through specific pathways.
Why does provider revalidation matter for assisted living Medicaid billing?
If enrollment is outdated, Medicaid claims can be denied regardless of care delivered. Federal regulation requires revalidation at least every five years.
A 90 day transformation is realistic when you focus on the few controls that drive most outcomes. Your assisted living revenue cycle improves when intake is tight, services are documented clearly, authorizations are tracked, and billing follows a clean claim gate.
Key takeaways
- Fix move in handoffs and resident responsibility collections first
- Verify eligibility and payer path on a schedule, not only at move in
- Track authorizations and units with alerts and clear ownership
- Standardize documentation so it supports billing
- Reconcile payments to catch underpayments and adjustments
If you want faster cash flow, fewer denials, and a calmer business office, LTCPro can help you build an assisted living revenue cycle that runs smoothly even when staffing is stretched. What is your biggest bottleneck right now, intake accuracy, waiver billing, denials, or collections?
