Unpaid claims, followed up
Accounts Receivable Management for Private Practices
Medtransic follows up every unpaid insurance claim until it is paid, corrected or closed, starting with the claims closest to their filing deadlines. Accounts receivable follow-up is part of our billing at 4-8% of collections, and your client portal shows what is outstanding and how old it is.
How We Run AR Management
Our approach is built on transparency - you see exactly what we're doing, why, and what it produces.
Every Outstanding Claim Gets Worked
Follow-up stops being a spare-time activity and becomes someone's entire job. A dedicated team reviews your outstanding claims daily and works them in deliberate order - the claims nearest their filing deadlines and worth the most first - with every touch logged, every payer response recorded, and every claim pursued to an endpoint: paid, corrected and repaid, or a documented, justified write-off. Nothing sits untouched simply because no one got to it.
- Your claims reviewed and prioritized daily
- Oldest, at-risk claims chased first
- Deadlines tracked so claims don't expire
- Every claim pursued until it's paid or resolved
We Catch Payers Who Underpay You
Your payer contracts get loaded as the measuring stick, and every payment that arrives is compared against what that contract says the service should have paid. Shortfalls get flagged automatically, disputed with the payer, and tracked to recovery - and when the same payer shorts the same service repeatedly, that pattern gets documented and escalated rather than treated as a series of coincidences.
- Every payment matched to your contract
- Underpayments caught and recovered
- Payer shortfalls flagged automatically
- Money you're owed pursued, not written off
People Who Know How to Get Payers to Pay
The specialists working your claims do this all day, across many payers, and it shows in the results: they know which claims a phone call will move and which need a formal escalation, what information to have ready so a call resolves the claim instead of ending in 'we'll look into it,' and when a payer's stalling has crossed into something worth putting in writing. Experience is the difference between follow-up that documents a claim's stagnation and follow-up that ends it.
- Direct payer contacts, not endless hold music
- Stuck claims escalated until they move
- Persistent follow-through without burning bridges
- Faster resolution on claims that were going nowhere
A Clear Picture of What You're Owed
You get reporting that answers an owner's actual questions: how much is outstanding, how old it is, which payers are holding it, and whether the trend is improving month over month. When something should be written off, you'll see why - a documented reason, not a mystery adjustment. The guessing about your own receivables ends, and with it the end-of-year surprises.
- See your aging claims in every monthly report
- Know which payers are holding your money
- Track whether collections are improving
- Clear answers, not raw data dumps
Without systematic detection, underpayments are accepted as final and become permanent revenue loss.
Recurring Challenges in AR Management
Outstanding accounts receivable ties up cash flow and reduces practice profitability. These challenges prevent effective collections.
Money You've Earned Is Aging Out of Reach
Receivables decay on a curve. A claim thirty days old is usually just slow; by ninety days something is wrong with it; past that, industry experience is blunt - the odds of ever collecting drop steeply with every additional month. Aging buckets aren't a filing system, they're a countdown: the same dollar that was routinely collectible in month one becomes a long-shot phone call in month six and a write-off by year end.
Impact
Accounts over 120 days are the hardest to collect and the first to be written off
Unpaid Claims Sit Untouched Until It's Too Late
Every payer sets a final deadline for filing and correcting claims, and old claims don't announce themselves before they cross it. In a busy office, follow-up is whatever time is left after patients, phones, and new claims - which means the oldest receivables, the ones closest to expiring, are precisely the ones nobody touches. Once the window closes, the debt is legally uncollectible no matter how valid it was.
Impact
Unworked A/R results in permanent write-offs and revenue loss
Payers Are Paying You Less Than They Owe
A payment arriving isn't the same as the right payment arriving. Your contracts specify what each payer owes for each service, but if no one reconciles actual payments against those contracted rates, shortfalls get posted as if they were correct and the difference evaporates. Individually the variances look too small to chase; across a year of claims they're a material percentage of revenue that leaked without a single denial being issued.
Impact
Underpayments go unnoticed because a short payment still looks like a paid claim
Chasing Claims Is Draining Your Front Desk
Claim follow-up done by whoever can spare a moment produces exactly what you'd expect: long hold times eating staff hours, inconsistent notes, and claims touched once and forgotten. Meanwhile the person doing it was hired to run your front office, and that job suffers too. You end up paying twice - once for the labor, again for the receivables that still aren't moving.
Impact
High labor costs with low recovery rates strain operations
Stalled Claims Take Forever to Resolve
A stuck claim rarely resolves itself; someone has to figure out why it's stuck, reach the right person at the payer, and push it through - and knowing how to do that quickly is a genuine skill. Without it, each call ends in 'it's in process,' weeks pass between attempts, and a claim that needed one well-aimed intervention instead accumulates months of age.
Impact
Slow claim inquiries delay cash flow
You Can't See What's Actually Owed to You
Ask most practice owners what's sitting in their receivables and the honest answer is a guess. Without aging detail by payer and by claim, you can't distinguish money that's genuinely coming from money that's already functionally lost, can't direct effort at the claims that matter most, and can't tell whether the follow-up you're paying for is producing anything. Uncertainty about your own receivables is itself a cost.
Impact
Unable to focus on high-value accounts or problem payers
What You Get With AR Management
Every component managed with precision and expertise.
Outstanding Claim Follow-Up
Systematic pursuit of all unpaid claims with payer outreach, status tracking, and resolution management.
Daily claim status monitoring / Payer inquiry and follow-up / Documentation requests / Escalation procedures
Payment Variance Analysis
Detailed review of all payments to identify underpayments, incorrect adjustments, and recovery opportunities.
EOB analysis / Contract verification / Underpayment recovery / Adjustment validation
A/R Reporting & Analytics
Detailed reporting on A/R performance with aging analysis, collection metrics, and trend identification.
Aging bucket analysis / Payer performance reports / Collection trending / Custom dashboards
Patient Balance Management
Professional patient billing and collection services that maintain positive relationships while maximizing recovery.
Patient statement generation / Payment plan setup / Courteous follow-up / Financial counseling
Accelerate Your Cash Flow
Our A/R management team recovers outstanding balances and reduces days in A/R. See how we can transform your collections.
The Details of AR Management Coding
01Aging Bucket Analysis and Strategic Prioritization for Maximum Recovery
An aging report is not a list of what you are owed. It is a queue, and the order you work it in decides how much of it you actually collect.
What each bucket means
- 010-30 days. Normal processing. Monitor it; do not spend follow-up time here.
- 0231-60 days. Run the first payer status check. This is where you catch a processing delay, a pending information request, or an early denial while it is still cheap to fix.
- 0361-90 days. The inflection point. Call a payer representative, check the portal, and find the correctable denial reason rather than waiting another cycle.
- 0491-120 days. Appeal windows start closing. Anything here needs a decision this week, not next month.
- 05120+ days. Recoverable in part, but treat it as salvage and put the effort into stopping the next claim from getting here.
Work the queue by value, not just by age
A high-dollar claim at 61 days outranks a small one at 31 days, because the money and the urgency are both larger. Score each claim on age, dollar value, payer history, and how recoverable the denial reason is, then work the top of that list. Limited follow-up capacity is the real constraint, so it should be pointed at the claims most likely to convert.
02Denial Pattern Recognition and Systematic Appeal Strategies
A denial worked one at a time is a task. The same denial counted, categorized and charted is a diagnosis, and that is the difference between recovering this month and not losing it again next month.
Categorize before you appeal
Record every denial by reason, payer, service, provider and date. The patterns tell you where the failure actually is:
- One payer denying higher-level office visits for documentation usually means a template problem, not a payer problem.
- A spike in prior authorization denials for one procedure means the front-end authorization step is broken, not the claim.
- The same reason across every payer means the fault is inside your own process.
Escalate in order
- 01First level. File promptly, answering the specific denial reason with the documentation that addresses it.
- 02Second level. Where medical necessity is disputed, add clinical guidelines, literature, or a specialist letter.
- 03External review. For commercial plans, the state insurance department or an independent review organization once internal appeals are exhausted.
- 04Medicare. A five-level process from redetermination through the Medicare Appeals Council and ultimately federal court.
Tracking outcomes tells you which denials are worth appealing at all. Some are genuine claim errors that should be fixed at the source rather than appealed again every month.
03Payment Variance Detection and Contractual Underpayment Recovery
A short payment does not announce itself. The claim shows as paid, the balance closes, and the difference between what the contract says and what arrived is simply absorbed.
What underpayment actually looks like
- Wrong fee schedule. The payer pays an older or lower contracted rate than your current agreement specifies.
- Improper bundling. Separately billable services are paid as one.
- Modifier mishandling. A reduction is applied even though the modifier was used correctly.
- Downcoding. The payer pays for a lower-level service than the one billed, without clinical justification.
Detecting it is a data problem, not a diligence problem
Nobody catches this by reading remittances. It needs a current fee schedule for every contracted payer and an automatic comparison of each payment against the rate you are owed, with anything short of the expected amount flagged for follow-up.
Recovery here is not a denial appeal. The claim was paid, just paid wrongly, and many contracts set their own timeline and process for disputing that. Those windows are easy to miss precisely because nothing looked like it failed.
Understanding Payers for AR Management Billing
AR management strategies must be tailored to each payer's specific timely filing deadlines, appeal processes, payment behaviors, and denial patterns. Understanding payer-specific nuances is the difference between systematic revenue recovery and permanent write-offs.
- Medicare timely filing is 12 months from the date of service, but initial claim submission should occur within 30 days to allow time for denial resolution and appeals within the filing window.
- Medicare redetermination (first-level appeal) must be filed within 120 days of the initial determination. Track all denial dates and set automated alerts at 60 and 90 days to prevent missed appeal deadlines.
- Medicare Secondary Payer (MSP) claims require the primary payer EOB before Medicare will process the claim. Delays in obtaining the primary EOB are a leading cause of Medicare AR aging beyond 90 days.
- Medicare processes claims through MACs (Medicare Administrative Contractors) with jurisdiction-specific policies. Know your MAC and its specific processing timelines, contact methods, and escalation procedures for stuck claims.
- Medicare Advantage filing limits vary by contract. Verify the exact deadline for each MA plan in your payer mix to prevent write-offs.
- Medicare Advantage insurers denied 4.1 million of nearly 53 million prior authorization requests in 2024, a 7.7% denial rate, and traditional Medicare does not generally require prior authorization at all (KFF, published January 2026). Budget AR follow-up accordingly and track MA denials separately to find plan-level patterns.
- Appeals for MA plan denials follow different timelines than traditional Medicare: 60 days for standard reconsideration and 72 hours for an expedited decision. Track these deadlines separately from Medicare fee-for-service appeal timelines.
- MA plans frequently apply clinical editing rules beyond standard payer bundling rules that result in unexpected denials. Build a payer-specific edit library for your highest-volume MA plans to prevent recurring denials.
- Commercial filing limits vary by contract. Maintain a payer-specific deadline matrix and prioritize AR follow-up based on approaching deadlines.
- Commercial payer underpayment disputes require submitting a formal written request with the contracted rate documentation. Verbal disputes are typically not honored. Keep copies of all executed payer contracts accessible to the AR team.
- Commercial payers increasingly use automated claims adjudication systems that apply proprietary bundling edits. When claims are incorrectly bundled, appeal with documentation showing the services are separately payable.
- No Surprises Act protections for out-of-network emergency claims create a separate payment dispute pathway through Independent Dispute Resolution. Track eligible claims separately and file within the initiation window.
- Establish a daily AR workflow that assigns specific payer groups to dedicated follow-up staff. Payer specialization allows staff to develop expertise in each payer portal, phone system, and appeal process for faster resolution.
- Implement a three-touch follow-up protocol: first contact at 35 days (payer status check), second contact at 50 days (formal inquiry with documentation), and third contact at 70 days (supervisor escalation or appeal filing).
- Track write-off rates by category (timely filing, provider adjustment, small balance) and set maximum thresholds for each, so a rising category triggers a root cause investigation rather than a shrug.
- Monthly AR performance reporting should include days in AR, aging distribution, collection rate, denial rate, and net collection percentage, benchmarked against published standards for your specialty and practice size.
The Eventual Benefits for Your Practice
Beyond immediate revenue recovery, our AR management delivers transformational long-term outcomes
Predictable Cash Flow. Consistent monthly collections replace unpredictable revenue cycles. You'll know exactly what's coming in, allowing for confident business planning, staff expansion, and equipment investments without financial uncertainty.
Freedom to Focus on Patient Care. Your staff stops spending hours on hold with insurance companies and chasing payments. They redirect that time to patient care, appointment scheduling, and practice growth initiatives that truly matter.
Maximized Practice Valuation. Clean A/R with minimal aging significantly increases your practice's value. Whether you're planning for retirement, seeking investment, or positioning for acquisition, strong collections metrics make your practice more attractive and valuable.
Reduced Financial Stress. Eliminate the anxiety of aging accounts receivable and mounting unpaid claims. Sleep better knowing experienced specialists are systematically working every dollar owed to your practice with proven results.
Competitive Advantage. Strong cash flow allows you to invest in new technology, hire top talent, and expand services while competitors struggle with collections. Your financial stability becomes a strategic advantage in attracting both patients and staff.
Sustainable Practice Growth. Recovered revenue becomes working capital for expansion. Open new locations, add providers, launch new service lines, or upgrade equipment knowing your financial foundation is solid and collections are optimized.
Time to Fix Your AR Management Process
Let's put a plan against your aging claims and turn stalled receivables back into cash.