Accounts receivable does not age because claims are difficult. It ages because nobody has a schedule.
Almost every practice with an AR problem is working hard at it. The work is simply unstructured — claims are chased when someone notices them, calls are made without reference to what happened last time, and the effort spreads evenly across balances of wildly different value. Structure, not effort, is what changes the outcome.
Segment before you schedule
Working AR as one undifferentiated list guarantees misallocated effort. Segment it first, at minimum by:
- Payer. Payers behave differently, have different portals and different escalation routes, and batching work by payer is materially more efficient than switching between them.
- Aging bucket. A 45-day claim and a 200-day claim need different actions, not the same action performed later.
- Value. Effort should be proportional to what is recoverable.
- Status. Denied, rejected, no response and patient responsibility are four different jobs.
Segmentation on its own usually produces an uncomfortable finding: a large share of open balances are small, old and functionally uncollectable, while a smaller number of high-value claims have had almost no attention.
Set a cadence per segment
Once segmented, give each segment a defined rhythm — how often it is worked and through which channel. The specific intervals matter less than the fact that they exist and are followed. A cadence removes the question of what to work today, which is the question that quietly consumes the most time.
High-value recent claims warrant the tightest cadence, because they are the most recoverable and the most sensitive to delay. Old, low-value balances warrant the loosest — or a decision to close them.
Document every touchpoint
This is the highest-leverage habit in the whole discipline, and it is the one most often skipped under time pressure.
Every contact should record the date, who was spoken to or which portal was used, what the payer said, what was agreed, what happens next, and when it will be checked. Without that, three things happen: every call restarts the conversation, payer commitments cannot be held to, and the practice has no evidence when it needs to escalate.
A documented history is what turns the fourth call from a repetition into an escalation.
Know when to stop calling and start escalating
A claim that has been "in process" through three status calls does not need a fourth. It needs escalation through the payer's own channels, supported by the history showing what was previously promised.
Repetition feels like diligence and is frequently the opposite — it keeps the claim technically active while nothing changes. The documented touchpoint history is what makes the escalation credible.
Work rejections separately from denials
Rejections stopped before adjudication never appear in denial reporting and are usually quicker to fix. If they are sitting inside your general AR follow-up queue, they are being worked at the wrong pace and with the wrong urgency, and they are closer to their filing deadline than their date of service suggests.
Separate patient balances
Patient AR needs a different approach from payer AR: statements, payment plans, clear communication and an agreed escalation limit. Working it in the same queue as payer follow-up means one of the two is always being done badly, and it is usually the patient side — which is also the side where the practice's reputation is at stake.
Close what is dead
Balances that cannot be recovered should be closed with a documented reason. Carrying them:
- inflates the AR total and days in AR
- makes the aging report harder to read every month
- hides the performance of the balances that are collectable
- consumes attention in every review
Closing them is not giving up. It is the only way the remaining number means something.
Measure movement, not just the total
The most useful AR report is not the balance. It is movement between buckets: what came in, what was collected, what aged into the next band, and what was closed. A flat total can conceal healthy churn or a stagnant backlog, and only movement distinguishes them.
Where to start on Monday
- Segment open AR by payer and aging bucket, sorted by value.
- Identify the twenty highest-value claims over 90 days and find out, specifically, what is holding each one.
- Write down a cadence for each segment and put it in the diary.
- Start recording touchpoints on every claim, from today, even if the history before today is missing.
None of that requires new software or additional headcount. It requires deciding, once, what gets worked when — which is the decision most practices have never actually made.
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Get a Free Billing & AR AssessmentFrequently asked questions
How often should open claims be worked?
That depends on the segment. Recent high-value claims justify a tighter cadence than small aged balances. The important thing is that the cadence is defined per segment rather than left to whoever has time.
When should a claim be escalated rather than chased again?
When correct follow-up has been performed, the documented history shows repeated payer commitments that were not honoured, and a further status call would produce the same answer. At that point repetition is not diligence, it is delay.
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This article is general information about medical billing and revenue cycle management for US practices. It is not legal, coding or compliance advice, and payer rules vary by payer, plan and state. Check the position that applies to your own practice before acting on anything here.