Work A/R aging buckets

For: RCM Specialist · Time: 2–4 hours weekly · Frequency: Weekly deep-dive; daily glance

Trigger

Weekly cadence to keep A/R clean. Or your owner flagged in month-end review that 90+ days is growing. Or a specific practice's A/R spiked.

Outcome

Every claim aged 60+ days has been touched in the past 14 days — called on, appealed, escalated, or written off with documentation. Nothing rots silently.

Where

• RCM → A/R Aging tab — bucketed view with by-payer breakdown
• RCM → Claims — filter by age
• Communication Logs — record every call/email per claim

Steps

1. Open A/R Aging tab. See buckets: 0–30, 31–60, 61–90, 90+. The 0–30 bucket is normal (claims in flight). 30+ days needs attention; 90+ is urgent.
2. Drill into 60+ day buckets first. Click bucket → list of claims. Filter by payer to find concentration.
3. For each claim, classify the cause before working it:
   • Never paid, no response — payer claims they never got it; resubmit with proof of timely filing.
   • Pending payer review — payer says "in process"; chase weekly until adjudicated.
   • Denied, not worked — denial sitting in inbox; route to Denial Inbox playbook.
   • Partial paid, balance not pursued — usually patient-responsibility balance not billed to patient; generate statement.
   • Disputed amount — practice disagrees with adjudication; needs appeal.
4. Pick up the phone. Email/portal status checks for 60+ day claims rarely move the needle. Call the payer's claims department. Have the claim number, NPI, DOS, billed amount ready.
5. Log every contact. Communication Logs → new entry → tie to claim → record: who you spoke with (name + ext), what they said, what they're doing, when to follow up.
6. Take action based on call outcome:
   • "We never received it" → resubmit with proof-of-timely-filing letter, change status to resubmitted.
   • "Paid on YYYY-MM-DD, check #XXX" → check the practice's bank; if missed, work with the bank or request reissue.
   • "Denied for X" → push the denial back into your inbox for the proper workflow.
   • "Patient policy was termed on YYYY" → re-verify eligibility, bill correct payer or move to patient.
7. Set followup. Every touched claim gets a followup date — usually 14 days. Use Followups to surface them next week.
8. Write off when appropriate. If the claim is past timely-filing limits, beyond appeal, and the practice agrees: write off with documented reason. Big write-offs (>$500) need Agency Owner approval.

Watch-outs

• A/R growth is a leading indicator of agency health failure. If 60+ days is growing month-over-month, you have a workflow problem, not a billing problem. Diagnose: is denial work falling behind? Statement generation? Eligibility verification?
• One payer dominates A/R for most practices. Often Medicaid or a slow commercial. Drilling into A/R-by-payer surfaces it. Once you know the bad actor, address it systematically (e.g. dedicated time block per week for that payer).
• Timely filing windows are MERCILESS. Most commercial: 90–180 days from DOS. Medicare: 12 months. Medicaid: 90 days–18 months by state. Past the window = you cannot collect, period. Watch the calendar.
• "Pending review" can be a stall tactic. Some payers say "in process" forever. Escalate to the payer's provider relations rep (each commercial payer has one assigned to your tax ID) when "pending review" hits 60 days.
• Don't double-resubmit. If a claim shows "rejected at clearinghouse" you can resubmit. If it shows "submitted, in process at payer" — DO NOT resubmit; you'll get duplicate denials and the original may get lost in the duplicates.
• Write-offs need contractual vs bad-debt distinction. A contractual write-off (CO-45 below fee schedule) is normal and automatic on ERA post. A bad-debt write-off (uncollectable patient balance) needs accounting treatment per the practice's books.

Related jobs

• Post an ERA file — clears 0–30 bucket on submission
• Work the Denial Inbox — resolve denials before they age into 60+
• Send a branded patient statement — move balance to patient

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