Accounts receivable (A/R) management
Every unpaid claim worked by payer, oldest and largest first.
Each unpaid claim gets a status check and the action that moves it, inside the payer’s filing and appeal deadlines. You see what was worked, recovered and at risk in one report each month.
- Worked
- Oldest & largest first, by payer
- Medicare filing limit
- 12 months from service
- Full-service rate
- 3–6% of collections
- Old A/R projects
- Quoted after a free review
What A/R follow-up covers
Your A/R is every dollar billed and not yet paid. Most claims pay on their own. The rest sit: never received, pended for records, paid short, or denied and never reworked. By the time anyone notices, some are close to a filing or appeal deadline.
We work that list every day. Each unpaid claim gets a status check on the payer portal or by phone, then the action that moves it. Denials go through our denial management process, sorted by reason code and corrected or appealed.
- Corrected claims and rebills to the right payer
- Records sent when a payer pends a claim
- Short payments checked against your fee schedule
- Appeals filed inside each payer’s deadline
- Old A/R from a previous biller, as a one-time project
If we run your medical billing, A/R follow-up is part of it. If you bill in-house, we can work the aging alongside your team, or only the old claims.
How to calculate days in A/R
Days in A/R is how long, on average, a charge takes to become a payment. The AAFP’s method: add the charges posted over a period, such as the last three months, subtract credits, and divide by the days in the period. That is your average daily charge. Divide your total A/R, less credit balances, by it.
For example, $270,000 in charges over 90 days is $3,000 a day. With $120,000 in open A/R, you are at 40 days. The AAFP suggests staying under 50 days, with 30 to 40 preferable.
An average can hide old money. One slow payer or a pile of claims past 90 days barely moves it, so we also report A/R over 90 and over 120 days, by payer.
How we work each aging bucket
Sorted by payer, worked oldest and largest first. A claim near a filing or appeal deadline jumps the queue.
- 0 to 30 daysRejections fixed and resent. Claims the payer has not acknowledged are confirmed as received.
- 31 to 60 daysStatus checked on every unpaid claim. Pended claims get the records the payer asked for.
- 61 to 90 daysPayer calls, corrected claims and appeals. Short payments compared with your contract.
- Over 90 daysWorked first, largest balances on top. Escalated to provider relations when a payer stalls.
- Over 120 daysReviewed claim by claim: collectable, appealable with proof of timely filing, or written off with a reason you approve.
- Patient balancesBilled to the patient only after insurance has paid or denied.
How we work your A/R
Pull the aging
Your aging report by payer and claim, with the ERAs and EOBs behind each balance.
Sort by deadline and dollars
Claims near a filing or appeal limit first, then the oldest and largest balances.
Find out why it is unpaid
Not received, pended, denied, paid short or paid to someone else.
Act and follow up
A corrected claim, rebill, records or appeal, followed up until the claim closes.
Fix the cause
Repeat problems go back to the step that caused them, from eligibility to charge entry.
Timely filing limits, and the payer’s deadlines
Medicare claims must be filed within one calendar year (12 months) of the date of service under 42 CFR 424.44, with narrow exceptions such as retroactive entitlement. For Medicaid, federal rules require states to have claims submitted within 12 months of the date of service; a state’s own rule or a managed care contract can be shorter.
Commercial limits come from your contract or the payer’s provider manual, and they vary by payer, plan and state. We track each one and keep clearinghouse acceptance reports, the proof that wins a timely-filing appeal.
Payers have deadlines too. State prompt-pay laws require insurers to pay clean claims within set times, and the rules differ by state and plan type. In Texas, for example, they cover services under an HMO or insured PPO plan, according to the Texas Department of Insurance.
Corrected claim, reopening or appeal
A corrected claim fixes an error on the claim, such as a wrong code, modifier, date or member ID, and is resent inside the filing limit. An appeal argues that a claim processed as billed should still be paid, on grounds such as medical necessity, and goes in with records.
Medicare treats small mistakes differently. Its contractors must handle clerical errors, including minor errors and omissions, as reopenings, not appeals, and you can ask for a reopening for any reason within a year of the initial determination (42 CFR 405.980). A redetermination, the first appeal level, is due within 120 days of receiving the initial determination.
The CMS appeals booklet sets out every level. In 2026, an ALJ hearing needs $200 in dispute and federal court $1,960.
Medicare appeal levels and deadlines
Each level has its own clock. A notice is presumed received five days after the date on it.
- 1. Redetermination (MAC)Within 120 days of receiving the initial determination. No minimum amount.
- 2. Reconsideration (QIC)Within 180 days of receiving the redetermination.
- 3. ALJ hearing (OMHA)Within 60 days of receiving the reconsideration. At least $200 in dispute in 2026.
- 4. Medicare Appeals CouncilWithin 60 days of receiving the OMHA decision or dismissal.
- 5. Federal district courtWithin 60 days of receiving the Council’s decision. At least $1,960 in dispute in 2026.
Credit balances and refunds
A credit balance is money that may not be yours: a duplicate payment, a patient overpayment, or a payer that paid twice or paid as primary when it was secondary. Credits also make your A/R look smaller than it is.
Medicare overpayments have a hard deadline. Under 42 CFR 401.305, they must be reported and returned within 60 days of being identified, or by the cost report due date if that is later. The clock can be suspended for up to 180 days during a timely, good-faith investigation, and the rule looks back six years.
We list every credit monthly with its cause, prepare refunds for your approval, and check each payer’s refund request against the remittance and your contract first.
What we need from you
Access and documents, once. We work inside your systems.
- A signed BAA (we send ours)
- Aging report by payer and claim
- Access to your PM or EHR
- Clearinghouse login and reports
- Payer portal logins
- ERAs and EOBs for open claims
- Payer contracts or fee schedules
- Notes from your previous biller
What the monthly A/R report shows
The same lines every month, by payer.
- Days in A/RAverage time to payment, and the change since last month.
- Aging by bucketOpen balances at 0–30, 31–60, 61–90, 91–120 and over 120 days.
- A/R over 90 daysIts share of the total, and the payers behind it.
- Worked and recoveredClaims touched, actions taken and payments on old claims.
- At riskClaims close to a filing or appeal deadline, with the date.
- Write-offs and creditsEvery adjustment with its reason, and open credit balances.
- Root causesThe steps behind repeat problems, and what changed.
The AAFP suggests keeping days in A/R under 50, with 30 to 40 preferable. Specialty and payer mix move the number, so track your own trend month to month, and watch the share of A/R over 90 days, which a good average can hide.
Yes, where the claims are still inside the payer’s filing or appeal window. We review the aging claim by claim, work what is collectable oldest and largest first, and tell you plainly what is not. A claim denied for late filing can sometimes be appealed with proof it went out on time, such as a clearinghouse acceptance report.
If we run your full revenue cycle, A/R follow-up is part of our full-service rate of 3% to 6% of monthly collections, with eligibility checks, prior authorizations, coding, claims, posting and denials, and no setup or onboarding fees. A/R-only work and one-time clean-ups of old claims have no published price: we quote them after the free A/R review. Our guide to medical billing costs shows how to compare quotes.
Denial management works claims the payer has refused, by reason code, with corrections and appeals. A/R follow-up covers every unpaid claim, including ones with no answer at all: never received, pended for records, paid short or stuck in review. Many of the oldest claims on an aging report were never denied. Nobody asked about them.
Yes, once insurance has paid or denied. Patient balances go on statements with the reason shown, and our patient billing and support team answers the calls that follow and sets up payment plans under your policy. We do not move a balance to the patient while a payer could still pay it.
Yes. We don’t list our clients on this site, but ask us and we’ll arrange it: with a current client’s permission, we share their contact details so you can hear how we work from them directly.
From our guides
How to calculate days in A/R
The formula with a worked example and a calculator, the benchmarks, why a good average can hide old claims, and the fixes that bring days in A/R down.
How much do medical billing services cost?
The four ways billing companies price their work, the fees that sit outside the rate, and in-house arithmetic built from BLS data, so you can compare quotes on your own numbers.
Specialties we work with
Send us your last 90 days of A/R.
We’ll review it free and show you what is collectable, what is close to timing out and what it would take to recover.