A/R follow-up discipline

A/R aging categorizes outstanding balances by how long they have been unpaid. The standard buckets, 0-30, 31-60, 61-90, 91-120, and 120+ days, give a quick snapshot of where balances are accumulating and which ones are most at risk. Claims in the 120+ day bucket represent both a collection challenge and a timely filing risk, since many payers limit how long after the service date claims can be appealed or resubmitted.

The goal is not a zero A/R balance, some outstanding claims are always in process. The goal is a healthy distribution, where the majority of balances are in the 0-60 day range and the 90+ day bucket represents a small fraction of total outstanding revenue.

Not every aging claim deserves equal follow-up effort. A structured priority system helps billing staff allocate their time to the accounts most likely to generate collection and most at risk of expiring. Dollar value, payer, and aging status should all inform where follow-up effort goes first.

• Work 90+ day claims as a priority, particularly those approaching payer timely filing limits
• Segment follow-up by payer, some payers have faster response cycles than others
• Sort each aging bucket by dollar value and work highest-value claims first
• Batch claims by payer where possible to reduce per-call overhead
• Separate insurance A/R from patient A/R and manage each with distinct workflows

Follow-up without a defined timeline is not really follow-up, it is hope. Practices that perform well in A/R management have defined standards for when follow-up begins and how frequently it recurs for each claim. These standards vary based on payer processing times but typically include an initial follow-up at 30 days for government payers and 21 days for commercial payers, with weekly or bi-weekly follow-up thereafter.

• Define a standard first follow-up date for each major payer category
• Document every follow-up action taken on each claim
• Set a secondary follow-up date at the time of each contact if the claim is not resolved
• Confirm that follow-up standards are being met consistently through periodic audits
• Flag claims that have missed follow-up milestones for supervisory review

Some claims require escalation beyond standard follow-up, a formal appeal, a physician review, a supervisor call, or in some cases a decision to write off a balance that is not recoverable. Having a clear escalation pathway means that unresolved claims do not simply age in the queue while staff continue placing calls with no resolution.

Escalation thresholds vary by practice but typically include age in A/R, dollar value, and number of follow-up attempts. Claims meeting escalation criteria should be reviewed by a billing supervisor or manager who can determine the appropriate next action.

The only way to know whether A/R follow-up discipline is improving is to measure it consistently. Days in A/R, percentage of A/R over 90 days, collection rate by payer, and write-off rate are the core metrics that reflect the effectiveness of follow-up routines. Reviewing these monthly and comparing to prior periods makes performance trends visible, and gives billing leadership a basis for targeted improvement.

• Track days in A/R monthly and compare against your target and prior quarter
• Monitor the percentage of total A/R sitting in the 90+ day bucket
• Compare collection rates by payer to identify underperforming contracts
• Review write-off rates and investigate any unusual increases
• Set A/R performance goals and review progress quarterly