Having a plan for accounts receivable follow-up: the weekly routine that keeps money moving
In many practices, follow-up calls are not made, appeals are not sent, and denials sit unworked. The biller who drafted the first version of this post in 2014 had seen this in many offices and named the cause: accounts receivable follow-up was treated as something to do when there was time, by whoever had it. The fix has not changed. Give the work one owner, a few numbers to watch, and a weekly routine. What has changed is how much of the routine can now be done without a phone call.
Most practices have old balances on their aging report. The plan below reduces them.
One owner
Cross-training is good; shared ownership of A/R is not. When three people each work denials “when they can,” the same denial gets touched three times or not at all, and nobody sees the pattern behind it. Assign the receivable to one person, or one small team with a split by payer, and protect the time. In a small practice that may be two mornings a week, but the follow-up is assigned to a named person with a calendar slot, the same as payroll.
The owner also spots problems early: the person who works every denial is the first to notice a payer rejecting a modifier or a new provider’s enrollment that never finished, the patterns the 2014 draft said are “missed by several people handling the receivables on the fly.”
The numbers to watch
You need four numbers, measured the same way every month.
| Measure | How to calculate it | What it tells you |
|---|---|---|
| Days in A/R | Total A/R divided by average daily charges (MGMA’s definition) | How long, on average, money sits between service and payment |
| Aged A/R as a percentage of total A/R | Balances in each bucket (0 to 30, 31 to 60, 61 to 90, 91 to 120, over 120 days) divided by total A/R; HFMA’s MAP Key AR-3 | Whether old balances are growing |
| First-pass denial rate | Claims denied on first submission divided by claims submitted | How accurate claims are when first sent |
| Actionable denials outstanding | Count and dollars of denials you can still fix and resubmit | This week’s work list |
Two reference points from sources worth reading in full. MGMA’s benchmarking has shown first-pass denial rates of 7 to 8 percent across the past four years, and its 2025 data suggests practices can get below 5 percent with targeted fixes. MGMA’s 2021 DataDive put the median share of total A/R over 120 days for multispecialty practices at 13.54 percent; it is an older figure, and your own trend month to month matters more than anyone’s median.
The weekly routine
| Day | Task |
|---|---|
| Monday | Post everything that arrived over the weekend: 835 remittances, lockbox, patient payments. Run the new denials list from the remittances. |
| Tuesday | Work denials, highest dollar first, then nearest appeal deadline. Correct and resubmit what can be corrected; start appeals on what cannot. |
| Wednesday | Claim status on everything unpaid past the payer’s normal turnaround. Portals and the 276/277 claim status transaction first; phone only for what the portal cannot answer. |
| Thursday | Appeals. Pull the template, change the patient facts, attach the records, send, log the date and the payer’s appeal deadline. |
| Friday | Patient balances and statements. Then the timely filing check: anything approaching a filing limit goes out this week, not next. |
Monthly, run the aging by payer and compare the four numbers to last month. Quarterly, review the five most common denial reason codes and ask what earlier fix would prevent each one.
Tools that reduce phone calls
The 2014 draft already recommended payer websites as the way to find a missed EOB without calling; in 2026 most follow-up should start there.
- Payer portals show claim status, remittance images and often the detailed reason behind a denial code. A missing payment can usually be found and posted without a call.
- 835 remittances carry the claim adjustment reason codes (CARC) and remark codes (RARC) that explain why a line was underpaid. Learn the handful that recur for you: CO-16 (missing information, read the RARC), CO-197 (no authorization), CO-29 (timely filing), PR-1 and PR-2 (patient deductible and coinsurance, which are not denials at all).
- When you must call, have the claim number, dates, billed amount and the question written down, get the representative’s name and a reference number, and ask every related question in that one call.
The appeal file
Every payer has its own appeal process, address and deadline, and payers enforce them strictly. Keep a file per payer: where appeals go, the form they want, the first-level and second-level deadlines, and what has worked. Keep your appeal letters as templates by denial type, so writing the next one means changing the patient, the dates and the claim number.
Timely filing limits
Medicare fee-for-service claims must be received within 12 months, one calendar year, of the date of service, and a claim denied for untimely filing has no appeal rights. Commercial payers set their own limits, often shorter. The Friday check exists because this is the one denial that cannot be fixed afterward: a claim that is 10 months old should be sent now and corrected later, not held until it is perfect and past the limit.
Worked example: reading one aging report
An illustrative freestanding practice has 600,000.00 in total A/R at month end.
| Bucket | Balance | Share |
|---|---|---|
| 0 to 30 days | 282,000.00 | 47 percent |
| 31 to 60 days | 120,000.00 | 20 percent |
| 61 to 90 days | 66,000.00 | 11 percent |
| 91 to 120 days | 42,000.00 | 7 percent |
| Over 120 days | 90,000.00 | 15 percent |
The over-120 share is 15 percent and was 11 percent three months ago. Sorting that bucket by payer shows 54,000.00 of it is one Medicare Advantage plan, and sorting by reason code shows most of those lines carry CO-197. That is not an A/R problem; it is an authorization problem from the spring, and the fix belongs in the authorization process. The remaining 36,000.00 over 120 days is patient balances with no statement sent in 60 days, which the Friday patient balance work covers. One report shows two problems, and fixing both reduces the over-120 balance.
What to do now
- Name the owner of A/R follow-up and put the weekly slots on the calendar.
- Build the four-number monthly report and keep every month, so the trend is visible.
- Start the per-payer appeal file and the letter templates this week, before you need them.
- Add a timely filing check to every Friday.
- If nobody in the office can keep to the schedule, contract for it, and require the outside team to report recurring findings back to billers and clinical staff, because the recurring problems are what need fixing.
- Iridium Suite’s accounts receivable work queues carry reminders and priority ordering so the owner’s list each morning is built from the aging and the remittances rather than from memory.