A claim in the 90-plus bucket is worth a fraction of the same claim at thirty days, and past the filing limit it is worth nothing at all. Old money has a deadline on it. Our medical accounts receivable services work insurance balances in deadline order, get real answers from payers instead of portal statuses, and record every step in your own system so the aging report becomes something you can manage from.
Deadline first, then oldest bucket
Aging is worked from the deadline down, because that is where the money disappears. Medicare gives you one calendar year from the date of service to file, and a late claim is denied under CO-29 with no right of appeal. Most commercial contracts allow 90 to 180 days, and some Medicaid programs less. Appeal windows are shorter still: 120 days for a Medicare redetermination, often 60 days for a commercial appeal. So the queue starts with any claim within 30 days of a filing or appeal deadline regardless of size, then the 120-plus bucket, then 90 to 120, then 60 to 90. Every claim touched gets a status, a next action and a follow-up date, not a note saying it was reviewed.
No response is a status too
A claim that has not paid and has not denied is the most dangerous kind, because nothing prompts anyone to look at it. We start with the clearinghouse: the 999 acknowledgment and the 277CA show whether the payer accepted the claim into adjudication, and a claim rejected there never reached the payer at all. From day 30 after acceptance, any claim with no 835 gets a 276 status inquiry, and a 277 response of "pending" or "in process" that repeats on the next check triggers a call. Payers lose claims, misroute them to the wrong plan and pend them for records without telling anyone. Each of those is fixable in month two and a write-off in month eleven.
Actual payer calls, with a reference number
Portal status checks are quick and frequently useless; a portal will say "in process" for ninety days. Where the portal and the 277 cannot explain a balance, someone calls the payer, gets a representative, asks the specific question and records the reference number, the name and what was said. Calls are batched by payer so one call covers several claims. The call log lives in your practice management system, so the next person to touch the claim, including your own staff, starts from the last answer rather than from nothing. That log is also the evidence when a payer later claims it never received a corrected claim or an appeal.
Underpayments and secondary balances
An unpaid balance is not the only leak in A/R. A claim paid at the wrong contracted rate posts as paid and vanishes from the denial queue, so we check the allowed amount on the 835 against your fee schedule for that payer, and a short payment is disputed as an underpayment with the contract clause cited. Contractual adjustments under CO-45 are expected; a large CO-45 on a code the contract prices higher is not. Secondary balances need the primary 835 attached and the CO-23 prior payer impact shown correctly, and a secondary claim sent without it comes back as CO-22. Patient responsibility under PR-1, PR-2 and PR-3 is moved to patient billing the day the primary and secondary have posted, so it does not sit in insurance A/R inflating the aging.
Credit balances count as A/R
A negative balance is a liability, not a bonus. Duplicate payments, primary and secondary both paying as primary, and posting errors all create credits, and Medicare overpayments have to be reported and returned within 60 days of being identified under 42 CFR 401.305. Most vendors ignore credits because they are not collections. We list them, confirm the cause against the remittances and tell you who is owed what, so refunds go out on your schedule rather than after a payer audit finds them.
Cleanup as a fixed-scope project
If the problem is a one-off backlog rather than an ongoing process, aged A/R cleanup is scoped and quoted on its own without moving your day-to-day billing. The first step is a free review of your aging: we take your A/R report, split it by payer and age, and mark each group as likely recoverable, past filing limits, or needing a decision from you. You get that back in writing, with the payer deadlines behind each call, before any work is priced. The review also shows where the backlog came from. Unposted remittances point at payment posting; a pile of untouched 277CA rejections points at claim submission; a stack of CO-16 and CO-97 denials nobody appealed points at denial management. Fixing the source is part of the scope, because otherwise the backlog rebuilds.
Why A/R follow-up fails when it is done badly
The most common failure is working the aging report by dollar value, which pushes small claims to the back until they cross the filing deadline and become write-offs. The second is confusing a status check with follow-up: noting that a portal says "in process" is not an action, and a claim can sit in that state past its deadline while looking as if it has been worked. The third is not recording the payer reference number, so the next person to touch the claim starts from nothing. The fourth is leaving dead balances and unrefunded credits on the report, which distorts the aging and hides the recoverable money behind it. Ask your current vendor for the call log on any ten claims over ninety days. The answer tells you which of these is happening.
What Is Included
- Aging worked by filing deadline, then oldest bucket
- 276/277 status checks followed by real payer calls
- No-response claims chased from day 30
- Underpayments checked against the contracted rate
- Credit balances and refunds identified
- Old A/R cleanup as a fixed-scope project
| Medicare filing limit | Medicare claims must be received no later than one calendar year after the date of service; late claims are denied and the denial is not appealableSource: CMS MLN, Medicare Billing: CMS-1500 and 837P |
|---|---|
| Medicare appeal window | A redetermination must be requested within 120 days of receiving the initial determinationSource: CMS, First Level of Appeal: Redetermination |
| Overpayment refunds | An identified Medicare overpayment must be reported and returned within 60 daysSource: 42 CFR 401.305 |
Medical Accounts Receivable Services: Common Questions
It depends on the payer filing and appeal limits that apply, not on the age alone. A Medicare claim eleven months out can still be filed; a commercial claim past a 90-day limit with no proof of timely filing cannot. The free A/R review exists to sort one from the other before anyone is paid to chase it.
Yes, where a balance is genuinely unrecoverable. Carrying dead balances makes your aging report useless as a management tool, and every recommendation comes with the reason: past filing limit, appeal exhausted, payer insolvent or contractual adjustment never posted.
Yes. Aged A/R recovery is commonly bought as a standalone fixed-scope project, and some practices never move their ongoing billing at all. Your staff keep submitting claims while we work the backlog behind them.
Any claim where the 277 status response or portal does not explain why it is unpaid, any claim with no response 30 days after acceptance, and any claim near a deadline. Calls are grouped by payer so each call covers several claims and each one gets a reference number recorded against it.
Yes. Overpayments and duplicate payments show up in the same aging report as negative balances. We identify them, confirm the cause against the 835 and tell you what is owed to which payer or patient, because Medicare overpayments have a 60-day refund clock once identified.
Yes. Status, next action, follow-up date and call references are recorded in your practice management system, so your staff can read them without asking us and they stay with you if you ever leave.