Chapter 31 — Exercises

How to use these. Sections C and F are the chapter: if you can bend days in AR four ways and then refuse to (C), and cost a pursuit before starting it (F), you can run an AR desk. Section G is the one with a statute in it — work it slowly, and notice how many of its answers are "stop and route this to compliance," which is itself the skill being tested.

Section I should be attempted before reading §31.12. Everything you need is in Chapters 28, 29, 30's outline, and Chapter 1's Encounter timeline.

Section A — What AR actually is (items 1–8)

A.1 Define accounts receivable in one sentence, and name two things it is commonly confused with that it is not.

A.2 Why is gross AR — AR stated at charges — inflated by construction? Which chapter established the premise?

A.3 What happens to an account's honest AR value at adjudication, and why does that make young AR and old AR different substances?

A.4 State the first cut every AR analysis should make, and give two ways the two halves behave differently.

A.5 Account 10-4471 on day 17 carries \$145.98. Decompose it, and name the workflow each component belongs to.

A.6 Why is the \$30.00 copay collected on day 0 not in AR at all?

A.7 State the book's sixth theme and describe, in ranges, what happens to collectability as a balance ages. Why does this chapter refuse to give the decay curve to a decimal place?

A.8 A consultant proposes reporting AR net of expected contractual adjustments ("net AR"). What problem does that solve, and what new discipline does it require to stay honest?

Section B — The aging report (items 9–17)

B.9 Name the conventional aging buckets.

B.10 State the three questions to ask about how any aging report was built, before reading it.

B.11 What is re-aging, when is it defensible, and what does it do to the report when it is the default?

B.12 Why must credits not be netted into the aging? What do old credits camouflage?

B.13 From §31.2's constructed report: verify that the buckets foot to \$412,300 and that AR over 90 is 17.2%.

B.14 Why is the 31–60 bucket "where the money is moving"? What is the cheapest place to fix the over-90 number?

B.15 Explain "read the aging as flow, not stock," and describe the thirty-second comparison that does it.

B.16 An administrator says "our aging looks great — almost everything is under 30 days." Name two innocent explanations and two worrying ones.

B.17 What does an aging report locate, and what does it say nothing about? Whose job is the rest?

Section C — Days in AR, honestly (items 18–28)

C.18 State the days in AR formula, and identify every term in it that requires a definitional choice.

C.19 From §31.3's inputs (AR \$412,300 gross, credits \$28,600, twelve-month charges \$2,920,000, ninety-day charges \$766,500): reproduce all four computations. Show your arithmetic.

C.20 Why does netting credits flatter the metric, and why is the flattery perverse?

C.21 What does the denominator window import into the metric? Which window is more stable, and what is the actual rule?

C.22 Explain why a large write-off improves days in AR on the day it happens, and why the metric cannot distinguish that improvement from collecting faster. What report must be read beside it?

C.23 Both the numerator and denominator are stated at charges. What cancels because of that, and what does not?

C.24 State the Tier-2 benchmark ranges for days in AR and the two cautions this book attaches to any benchmark.

C.25 What are HFMA's MAP Keys, and what problem do they exist to solve?

C.26 A practice's days in AR fell from 52 to 44 the month it converted practice management systems. List three definitional changes that could produce that drop with no performance change, and say what the manager should do across the seam.

C.27 (Chapter 29) State the denominator problem as Chapter 29 §29.7 framed it for denial rates, and show that days in AR has the same disease.

C.28 Write the one-paragraph definition block that should appear on a dashboard beneath "Days in AR," per §31.3 and §31.11.

Section D — AR over ninety, and the queue (items 29–40)

D.29 What does AR over 90 detect that days in AR cannot, and why?

D.30 From §31.4's decomposition of \$70,850: verify the components foot, and rank them by urgency.

D.31 Which component is "the number that hides in it," and what specifically is it losing while it sits?

D.32 Explain "old-and-known is fine; old-and-unexplained is the only bad old."

D.33 Give one scenario where a low AR over 90 is a symptom of failure and one where a rising AR over 90 is a symptom of improvement.

D.34 State §31.5's principle one, and list the three kinds of items to subtract from a follow-up queue before sorting it. Where does each go?

D.35 State the four-level sort order for the AR follow-up queue, and justify the position of each level.

D.36 Why does the queue sort on expected value at the allowed amount rather than on the charge? Which chapter's argument is that?

D.37 Explain the difference between an aging-fed queue and an event-fed queue, and list four event sources. What is the one-line version of the argument?

D.38 (Chapter 6, Chapter 29) Chapter 6 §6.8 said a billing queue should be sorted by "whatever destroys value fastest." Show that §31.5's sort order and Chapter 29 §29.5's are both instances of that rule.

D.39 What two things should a queue's own measurement count, and what does counting touches produce?

D.40 Diagnose this account history and prescribe the fix: "04/12 called payer — in process, F/U 30. 05/14 called payer — in process, F/U 30. 06/15 called payer — still in process, F/U 30."

Section E — Follow-up (items 41–48)

E.41 State the escalation ladder from cheapest tool to strongest, with one sentence on what each rung is for.

E.42 What can the portal and the 276/277 answer, and what can they not do?

E.43 List the five things a strong payer call leaves with that a weak one does not.

E.44 "In process" — what is the disciplined response to hearing it, per §31.6's 📞?

E.45 (Chapter 27) Where does "a note about a call" rank as proof of timely filing, and what follows for what call documentation is for and what it is not?

E.46 What is a provider relations representative, and what kind of problem is theirs rather than the call center's? What is a "project claim"?

E.47 What are state prompt-pay statutes, which plans generally sit outside them and why, and what does the existence of the ladder's top change even when it is never used?

E.48 Every patient-side touch should end with one of two things. Name them, and name the chapter that owns the patient-side tools.

Section F — Small balances and the arithmetic of giving up (items 49–58)

F.49 Define fully loaded cost and list what it contains beyond the wage. State the figure this book publishes in §31.7, per hour and per minute, and what kind of figure it is.

F.50 Define cost to collect. State the Tier-2 range and the warning §31.11 attaches to managing to it alone.

F.51 From §31.7's assumptions (statement \$1.75 + 2 minutes handling; about two cycles to pay): compute the cost of a statement cycle and the two-cycle cost, and derive a defensible patient small-balance threshold.

F.52 Work Balance 1 (\$4.15), Balance 2 (\$14.85), and Balance 3 (a \$2.40 payer variance). State the decision and the reasoning for each.

F.53 State the marginal rule for deciding whether to keep pursuing a partially pursued balance. What does it say about sunk cost?

F.54 State the section's most important rule about instances and patterns, and show it with the \$2.40 × 1,150 arithmetic. Which chapter's method sees the pattern?

F.55 Why must the small-balance write-off carry its own adjustment code, and who must read the category's total?

F.56 What five properties keep a small-balance threshold policy defensible on federal program claims, and which two statutes are implicated by routine cost-sharing waivers?

F.57 A \$3.40 balance the practice cannot collect versus a \$3.40 balance the practice owes: why does the threshold apply to one and not the other?

F.58 The office manager says: "Just write off anything under \$25 — chasing it annoys patients." Name what is right in that instinct, what is dangerous, and what the written policy should say instead.

Section G — Credits, unapplied cash, and the sixty-day rule (items 59–70)

G.59 Define a credit balance and list the five common causes. Which causes involve money owed to no one?

G.60 Why is "posting error, patient refund, or payer refund" the credit queue's triage, and why must it run before any money moves?

G.61 From §31.8's credit report: verify the causes foot to \$28,600, and identify the two lines that are compliance findings rather than housekeeping findings.

G.62 Define unapplied cash, give three ways it arises, and explain why "the damage is not the cash."

G.63 (Chapter 27) Which enrollment gap manufactures unapplied cash at scale, and what is the upstream fix?

G.64 Distinguish a credit balance from an overpayment in one sentence each.

G.65 State the sixty-day rule operationally: what must happen, within how long, from what starting point, and what a retained overpayment becomes.

G.66 What does "identified" mean under the CMS rule, what has never been a defense under any version of the standard, and what does this book tell you to do about the standard's exact current text?

G.67 Why does an overpayment that looks systemic require stopping rather than quietly refunding? Which chapter and section own the mechanism that handles it?

G.68 Work §31.9's recoupment sequence on this fact pattern: a demand letter recouping \$1,840.00 across six claims for "duplicate payment," where your records show two of the six were never paid twice.

G.69 On Medicare, what does filing the first-level appeal quickly do to recoupment, and why is that deadline different from the appeal's own filing limit?

G.70 State the two postings rules that keep the books honest through refunds and recoupments, and the one date that must always be captured contemporaneously.

Section H — Bad debt, charity care, and the dashboard (items 71–80)

H.71 Define bad debt and charity care so the difference is unmistakable, and state the sequencing rule that follows.

H.72 What does §501(r) require of tax-exempt hospitals before extraordinary collection actions, and what counts as an extraordinary collection action?

H.73 Why does blending the two write-offs corrupt both of the numbers they feed?

H.74 State four operational rules for collection agency placement, and explain "placement is delegation, not disposal."

H.75 What has been happening to medical debt on credit reports, and what does this book conclude about credit reporting as a collection tool?

H.76 Per §31.10's 📞: what are the two ways to hear "I just can't pay this," and what is the practice's actual protection against being gamed?

H.77 State the five disciplines of §31.11's dashboard, and for each name the earlier chapter it inherits from.

H.78 For each headline metric, name its blind spot and the paired number that detects it: days in AR · net collection rate · denial rate · collections.

H.79 Why does the dashboard print definitions on the page itself? Use Account 10-4471's two denial rates in your answer.

H.80 From §31.11's constructed dashboard: identify the one deteriorating number, explain why it outranks the 17.2%, and state what "test one story a month" would look like applied to this page.

Section I — The Encounter (items 81–86)

I.81 Reconstruct line 1's path through the aging buckets by date of service: which bucket was it in on day 17, day 47, and day 62, and when did it leave AR?

I.82 Verify the 49 days, and state what event marks each end of the interval.

I.83 The aging report never flagged line 1 as a problem. Should it have? What surfaced the line instead, and at which two moments?

I.84 Name the three costs of the 49 days as §31.12 prices them, and the currency each is stated in. Which conversion does the chapter deliberately not perform, and who performs it?

I.85 The patient's \$17.58 was 100 days old, by date of service, when it was paid — and the patient paid within 30 days of being asked. Reconcile those two sentences, and state the general lesson about aging bases.

I.86 As of this chapter, list the published inputs that Chapter 40's capstone will assemble, and where each was published. What may Chapters 1–39 not do with them?