How to reduce A/R over 90 days

Why claims age

Claims do not age because they are difficult. They age because nobody worked them, and the reasons are mundane: the person responsible left, volume grew faster than capacity, or denials were resubmitted rather than diagnosed so the same claims cycled without ever resolving.

That matters because reducing the backlog and preventing the next one are different jobs. Working the pile without fixing the cause means doing it again in six months.

Work the backlog in the right order

The instinct is to start with the largest balances. That is the wrong order, because it ignores the only deadline that actually removes money permanently.

1. Sort by filing deadline, not by value

Every payer has a timely filing limit. A claim past it is worth nothing regardless of its size. Anything approaching a deadline is urgent; a large claim with six months left is not.

2. Then by payer, not by claim

Claims denied for the same reason by the same payer are one problem, not thirty. Grouping turns a long list into a handful of decisions and is the single biggest time-saver in a cleanup.

3. Then by recoverability

Some aged claims are genuinely dead — denied correctly, past appeal, or for a patient with no coverage. Identify those and stop spending time on them. The goal is recovering money, not clearing a list.

What is realistically recoverable

Recovery probability falls with age, and the drop is steeper than most people expect.

• 91 to 120 days — most is still recoverable. Usually needs follow-up rather than appeal.
• 121 to 180 days — recoverable but harder. Appeals windows are closing and documentation takes longer to assemble.
• Past 180 days — mixed, and heavily dependent on payer. Some will still pay; some filing windows have closed entirely.

We have deliberately not put percentages on those bands. Recovery rates vary enormously by payer mix, specialty and why the claims aged in the first place, and any single figure would be wrong for most practices.

Fix the cause, or do this again next year

Once the backlog is moving, find out why it formed. The nine-point audit separates the usual causes, but the three that produce aged A/R are consistent:

• Denials not being worked — see whether yours are being worked or resubmitted.
• Not enough capacity — volume grew and follow-up was the first thing squeezed.
• No systematic follow-up — claims are touched when someone notices, not on a schedule.

You can buy this as a project

A/R cleanup does not require changing who does your billing. It is a defined piece of work with a defined end, and it can be bought on its own — which is often the right answer when billing is otherwise fine and the backlog is the legacy of one bad period.

If you want to understand the numbers first, how to read an aging report covers what the buckets actually mean.