A/R Recovery & Old Claim Cleanup

Old A/R isn't some mysterious black hole. It's just claims that someone, somewhere, stopped following up on. When more than 15% of your money is sitting past 90 days, you're basically handing payers an interest-free loan — and inching toward the point where you can't collect at all. Accounts receivable recovery for medical billing is really just treating that aging report like it matters every single week, instead of glancing at it once a month and sighing.

Read the aging mix before you dial anyone

Healthy outpatient mix roughly runs 65% in 0–30, 18% in 31–60, 9% in 61–90, 5% in 91–120, remainder in 120+. If 91–120 exceeds 8%, follow-up is broken. If 120+ exceeds 6%, write-off discipline is broken — dead claims inflate the report and hide the real problem. Then split the same report by payer. Medicare should clear in about 14–18 days; major commercials in 21–28. A payer stuck at 45+ days without active appeals usually means silent EDI rejections or no human working the bucket. Accounts receivable recovery for medical billing starts with that diagnosis, not with random phone blasts.

Prioritize by dollars near timely filing, not by oldest claim number. A $4,200 claim at day 88 beats twenty $40 claims at day 200. Our recovery work starts with a free 30-day analysis of buckets and recovery potential before anyone commits to a cleanup engagement.

What "working a claim" actually means after day 60

Portal "pending" status is not work. Work is a documented call: rep name, reference number, next action, and whether you need a corrected 837, medical records, or a formal appeal. For CO-16, supply the missing field and resubmit. For CO-97, test distinct-service modifiers with documentation. For CO-50, cite the LCD/NCD. For underpayments sitting under CO-45, compare the 835 allowed amount to the contract. If the clearinghouse shows an accept but the payer has no claim on file, you're chasing a ghost — reopen the EDI trail before you write another appeal letter.

Timely filing isn't always the end

Past timely filing, some dollars still move when you can prove payer delay, incorrect original rejection, or coordination-of-benefits errors. Document grounds carefully; don't mass-rebill and hope. Average recovery on aged A/R projects we take on lands in the 35–55% range depending on how old the inventory is and whether anyone touched it in the last year. First recovered dollars often show within 30 days once high-dollar near-deadline claims are worked. Contingency pricing is available when practices want recovery risk shared instead of a flat cleanup fee.

1. 1Export A/R by aging bucket and payer; sort by allowed dollars at risk.
2. 2Assign named owners to the top three payers by aged dollars for two focused weeks.
3. 3Call — don't only ping portals — and log every rep interaction in the PMS.
4. 4Re-run the 60+ bucket every Friday; that number dropping is the only early success metric that matters.

Cleanup without neglecting current claims

A/R recovery fails when the same two billers try to work 120+ inventory and keep same-week claims clean. Dedicated cleanup capacity — flat fee or contingency — protects current cash flow while the old bucket shrinks. Once 90+ days falls under control, hold days in A/R under 28 with the same follow-up cadence so you don't rebuild the backlog you just cleared. Net collection toward 98% is the long-term scoreboard; the aging report is the weekly one.