AR Follow-Up and Recovery

The standard buckets, current, 31 to 60 days, 61 to 90, 91 to 120 and over 120, tell you how long a balance has been open. They do not tell you why. A claim in the over-120 bucket might be sitting with a payer that has never adjudicated it, or it might have been denied in the first month and left alone ever since, or it might have been paid to the wrong location and never posted. Those three balances look identical on the aging and need entirely different work.

The bucket is also measured from the wrong date for most purposes. Aging runs from the date of service or the date billed, while every deadline that matters runs from something else: the payer's filing limit from the date of service, the appeal window from the denial date, the corrected-claim window from the remittance date. A balance can sit comfortably in the 61‑to‑90 bucket and already be past the point where it can be cured.

The bucket is also measured from the wrong date for most purposes. Aging runs from the date of service or the date billed, while every deadline that matters runs from something else: the payer's filing limit from the date of service, the appeal window from the denial date, the corrected-claim window from the remittance date. A balance can sit comfortably in the 61‑to‑90 bucket and already be past the point where it can be cured.

Never submitted: charges entered but with no clearinghouse acceptance on file, or a claim rejected at the front end and never resubmitted. These are not old claims. They are unfiled claims, and whether they are still filable depends on the payer's limit and the date of service.

Denied and unworked: a remittance arrived with a CO adjustment and a reason code, and nothing happened afterwards. Some of these are correctable, some are appealable, and each has a window that may or may not still be open.

Not collectible: balances that are past every available deadline through no fault of the payer, balances for services the plan did not cover with no patient responsibility to transfer, and balances so small that the cost of pursuit exceeds them. These are candidates for write-off, and the sooner they are identified the sooner the aging stops overstating what the practice is owed.

The fourth is often the largest: claims pending with the payer and simply not followed up. The payer has the claim, has not adjudicated it, and nobody has asked why. These are the most recoverable balances on any aging, and they are found by looking at what is missing rather than at what came back.

Within a payer, work proceeds by the nearest closing deadline, so that nothing recoverable becomes unrecoverable while older but safer balances are being chased. Every contact is logged with the date, the payer's reference number and what the payer said, so the next person to touch the claim starts from that record rather than from the beginning.

Where the original submission was the problem, the claim is rebuilt and resubmitted as a corrected claim with the appropriate frequency code, not as a new claim that will deny as a duplicate under CO-18.

What the follow-up work produces is a recommendation with the evidence attached: the claim, the reason it is considered unrecoverable, the deadline that has passed or the rule that applies, and the amount. The practice approves or declines each one, and the approved write-offs are posted with an adjustment code that records the reason so the ledger shows why the balance went, not only that it did.