Why receivables age
A claim rarely sits unpaid because one thing went wrong. More often it was rejected by the clearinghouse and never resubmitted, denied for a reason nobody had time to research, paid short and posted as if it were correct, or simply never followed up because newer claims were more urgent. The longer a claim waits, the harder it is to collect: payer filing and appeal deadlines pass, patients change coverage and staff who remember the visit move on.
How we work an A/R backlog
We do not work old claims in date order. Claims are triaged so effort goes where it can still be recovered:
- Deadline firstEvery open claim is matched to its payer’s timely-filing and appeal limits. Claims close to a deadline are worked first, because a missed deadline usually cannot be undone.
- Then by reasonClaims are grouped by status and adjustment reason — no response, rejected, denied for eligibility, authorization, coding or documentation — so one fix can clear many claims.
- Then by valueWithin each group, higher-value claims are worked before lower-value ones.
- Documented outcomeEvery claim ends paid, corrected and resubmitted, appealed, transferred to the patient’s responsibility, or written off with a documented reason you approve.
Proof of timely filing
When a payer denies a claim as late (adjustment reason code 29), the practice can often still be paid if it can show the claim was filed on time. Clearinghouse acceptance reports and payer acknowledgements are that proof, which is why we keep them for every submission and attach them to reconsideration requests. Medicare generally requires claims within one calendar year of the date of service; commercial limits are set in each payer contract.
Ongoing follow-up, not just clean-up
A clean-up project clears the backlog; ongoing follow-up keeps it from coming back. Unpaid claims are reviewed in aging buckets (0–30, 31–60, 61–90, 91–120 and 120+ days) and payer by payer, so a payer that has stopped paying a particular code is spotted quickly. The patterns behind slow claims are fed back to billing and the front desk — see how to reduce days in A/R for the causes we look for.
What you receive
- A starting inventory of open claims by payer, age and status.
- Weekly progress during a clean-up project, and monthly once follow-up is ongoing.
- A list of claims recommended for write-off, with reasons, for your approval — nothing is written off silently.