Aged A/R Is Not Dead Money. It Is Unworked Money.
Most practices do not have a billing problem. They have an aged A/R problem. Claims accumulate in the 60, 90 and 120 day buckets because no single person owns the follow-up, and by the time anyone looks, the balance has been written off as uncollectible. We work the aging report claim by claim, remittance code by remittance code and payer by payer, then report exactly what came back.
Why the Aging Report Keeps Growing
Aged A/R is rarely a coding failure. It is a follow-up failure, and it compounds quietly because an aging report is a document nobody is measured on.
Nobody owns the aging report
The report gets printed, circulated by email and skimmed in a huddle. Circulating is not working. Without a named owner, a follow-up date on every claim and a count of what was resolved last week, the aging report stops being a work queue and becomes a record of what the practice lost.
Timely filing clocks run in silence
Medicare allows one year from the date of service to submit an initial claim. Many commercial payers allow 90 to 180 days. Nothing in most practice management systems raises a hand when a claim is drifting toward that date, so the deadline passes unnoticed, and once it does no appeal, letter or phone call will bring the claim back.
Every remittance code is treated as one bucket
CO-16 for missing information, CO-27 for coverage terminated, CO-29 for timely filing, CO-45 for a fee schedule adjustment, CO-97 for a bundled service, CO-109 for the wrong payer and CO-197 for missing prior authorisation each require completely different work. When all of it is labelled denied and resent unchanged, the same claims come back rejected again and the effort produces nothing.
There is no escalation ladder
A first-level denial is not a final answer. Medicare runs redetermination, then reconsideration by a qualified independent contractor, then an administrative law judge hearing and a Medicare Appeals Council review. Commercial and self-funded plans have their own internal levels and, for some plans, external review. Practices that stop at level one leave the majority of appealable money on the table.
Underpayments never appear on a denial report
A claim paid below the contracted rate is not a denial. It is posted as payment, so it never enters the denial workflow and never gets appealed. Over a year that silent shortfall can exceed everything the practice argued about in denials, and it is only visible when paid claims are reconciled against the fee schedule or the contract.
Write-offs happen without a decision
At month end the remaining balances get adjusted off in bulk to close the period. Nobody in the room decides to abandon those claims. The decision is made by omission, and because no one recorded it as a decision, the same payer behaviour is discovered again the following quarter at the same cost.
Five Stages From Aging Report to Cash
Every claim gets an owner, a category and a next action date. That is the whole method, applied to every line in the file.
Triage the whole file
We take your aging report as it stands and segment every open claim by age, payer, remittance code and dollar value. Ranking is by recoverability rather than by size, because a small claim denied for missing documentation is often easier to recover than a large one stuck in a coverage dispute, and age alone does not tell you which is which.
Root cause each category
Each remittance code gets its own workstream. Missing information claims get corrected and refiled. Coding and bundling edits get reviewed against the documentation before anything is resent. Medical necessity denials get a clinical appeal with the record attached. Coordination of benefits and wrong payer claims go back out to the correct payer with the filing proof attached.
Resubmit clean and file appeals
Corrected claims go back through the electronic channel wherever the payer supports it, so they are not mistaken for duplicates of the original. Appeals follow the payer's own form, address, deadline and documentation list rather than a generic letter, because a well argued appeal sent to the wrong address on the wrong form is a denial with extra steps.
Escalate on a cadence
Every claim carries a next action date in the tracker. Claims without a response inside the payer's stated turnaround escalate to a provider representative, then to the next appeal level, and where the money justifies the effort, to external review. Nothing sits waiting on a portal that has not updated in three weeks.
Report it and stop the next wave
You receive a monthly report showing recoveries by bucket, by payer and by root cause, alongside the front-end changes that would prevent the same denials from being created next month. The recovery is the visible half of the work. The second half is that the 0 to 30 bucket stays clean, so the whole file shrinks rather than refills.
The Work Inside an A/R Recovery Engagement
Six workstreams that run against the same aging report at the same time.
Aged claim cleanup
Every open claim past 60 days worked individually, with corrected claims and appeals filed inside the payer's own window rather than bulk resent.
Denial and appeal management
Level one through external review, matched to the payer's requirements and to the amount at stake, so effort follows the money.
Underpayment recovery
Paid claims reconciled against contracted rates to find the shortfalls that never show up on a denial report.
Credit balance resolution
Credit balances and refund requests cleared inside the 60 day rule, so they do not become compliance exposure later.
Payer follow-up cadence
A scheduled next action on every claim, so nothing ages out while waiting for a portal to update.
A/R reporting and prevention
Monthly recovery reporting by bucket, payer and root cause, with the front-end fixes that stop the recurrence.
What Changes When Someone Owns the File
The same claims, the same payers and the same practice management system. What changes is who is accountable for each line.
| What changes | Without a process | With MedFactor |
|---|---|---|
| Who works the claim | Whoever has time that week | A named biller with a follow-up date on every claim |
| The oldest bucket | Left alone until it is written off | Worked in parallel with the fresh claims |
| Timely filing | Discovered after it expires | Tracked from the date of service on every claim |
| Appeals | One attempt, then abandoned | Escalated up the payer's own ladder |
| Underpayments | Not measured at all | Reconciled against the fee schedule and contract |
| Visibility | An aging report nobody owns | Monthly recovery reporting by cause and payer |
A/R Recovery Questions Answered
The questions practice managers ask before handing over a file that has been sitting for a year.
Practically, anything past 60 days from the date of service, and anything that nobody has touched this month regardless of its age. We work from 31 days onward and prioritise 90 days and older, because recoverability drops sharply as a claim ages. A claim at 45 days is a follow-up task. A claim at 150 days is a salvage operation with a filing deadline attached.
Yes, and telling you so is part of the job. If the timely filing window closed and no payer error caused the delay, the claim is gone and no appeal will revive it. Medicare allows one year from the date of service for an initial claim. Many commercial payers allow 90 to 180 days. Where the payer's own error caused the miss, the claim is still alive and we pursue it with the filing proof.
A billing service files claims as they are created and posts what comes back. A/R recovery is the work on the claims that already went out and were not paid correctly. Many practices already have the first and badly need the second. The two can run together, but they are different jobs with different daily queues.
No, and treating them alike is a common mistake. Medicare follows a defined ladder: a redetermination requested within 120 days of the initial determination, then reconsideration by a qualified independent contractor, then an administrative law judge hearing, then a Medicare Appeals Council review. Commercial and self-funded plans run on their own internal levels with ERISA timelines, and some plans allow external review once the internal levels are exhausted.
That is a proof of filing dispute rather than a clinical appeal, and it is worth pursuing. We pull the clearinghouse acknowledgement, the 277CA acceptance and the original electronic submission record, then present the payer with the evidence and ask for reconsideration. These disputes recover more often than practices expect, because most are resolved by the payer locating a claim it mislaid.
The first corrected claims and appeals go out within two to three weeks of the file being handed over. Cash typically starts landing in the second month, because payers take that long to process appeals and reprocessed claims. The oldest, most complex disputes can take longer, and we report on those monthly rather than leaving them silent.
Read access to the billing module or a scheduled report export is enough. If you work through a clearinghouse, we can also work the rejection queue and the aging report there. We do not need clinical access to patient notes for the majority of A/R work, and where an appeal needs documentation, we ask for specific encounters rather than the whole chart.
The review is free. You send the aging report as it stands and, if you have it, the last twelve months of remittance files. We segment it by bucket, payer and remittance code, then tell you what we believe is recoverable, what is dead on arrival and what the recovery is likely to be worth. You decide what to do with that with no obligation to engage us.
Find out what is actually recoverable
Send us your aging report as it stands today, however ugly it looks. We will segment it by bucket, payer and remittance code, then tell you plainly which claims are worth working, which are gone, and what the difference is worth to the practice.