Accounts Receivable — Systematic Follow-Up, Aging AR Recovery & Every Unpaid Claim Worked
Systematic follow-up on every open claim — no exceptions
Aging AR recovery before timely filing deadlines expire
Underpayment identification on every posted payment
THE PROBLEM
Why Medical Practice AR Is Almost Always Worse Than It Looks
Claims age because nobody is systematically following up.
The most common AR problem in medical practices is not complex — it is simply that nobody is making the calls, checking the payer portals, and following up on unpaid claims in a systematic, scheduled way. An in-house biller managing charge entry, claim submission, and posting for a busy practice has no time left for proactive AR follow-up. So claims sit. And age. And eventually become unrecoverable.
Timely filing deadlines create a countdown on every unpaid claim.
Every payer has a timely filing deadline — the window within which a corrected claim or appeal can be submitted. Medicare allows 12 months from the date of service. Most commercial payers allow 90–180 days. When a claim reaches its timely filing deadline without being worked, the revenue is permanently lost regardless of whether the claim was clinically valid and correctly coded. AR follow-up is not optional — it is a race against the deadline clock on every unpaid claim.
Payer underpayments are systematically accepted without question.
When a claim is paid, most practices post the payment and move on. What most practices never check is whether the payment matches the contracted rate. Payers routinely pay below contracted rates — processing errors, incorrect fee schedule application, wrong patient classification — and practices that do not verify payment against contracted rates silently accept underpayments on a significant percentage of paid claims. A $15 underpayment on one claim is noise. The same $15 underpayment on 500 claims per month is $7,500 in monthly lost revenue.
Patient AR is handled differently from insurance AR — and most practices blur the line.
Patient balances after insurance payment — copays, deductibles, coinsurance — require a different follow-up process than insurance AR. Patient statements, payment plans, collection referral decisions, and financial hardship considerations all apply to patient AR in ways that do not apply to insurance AR. Most practices handle patient AR as an afterthought — billing once, getting no response, and writing it off without a systematic follow-up process.
Previous biller AR is almost always a disaster.
When a practice changes billing companies, the previous biller's AR rarely comes with it cleanly. Claims that were submitted but never followed up, denials that were received but never appealed, and payments that were posted incorrectly all accumulate in a backlog that the new biller must either recover or write off. Most new billing relationships start with a significant inherited AR problem that takes 60–90 days to triage and work.
Patient balances require a different approach from insurance receivables. Our patient billing services help practices manage statements, payment plans, patient follow-ups, and outstanding balances while maintaining a professional and patient-friendly billing experience.
Our Services
What Netix Handles for Accounts Receivable Management
Insurance AR Follow-Up
Systematic, scheduled follow-up on every open insurance claim — payer portal status checks, follow-up calls to claims departments, and adjuster escalation for claims that exceed standard adjudication timelines. Every claim in the AR worked on a schedule based on payer behavior and timely filing deadline proximity — not when someone gets around to it.
Aging AR Recovery
Priority-based recovery of aged AR — claims approaching timely filing deadlines worked first, high-balance claims worked second, and systematic cleanup of the full aging bucket on a schedule. Every claim assessed for recoverability before write-off is considered — write-offs require documented work attempts and specific non-recovery reasons.
Underpayment Identification and Dispute
Every payment posted compared against contracted rates — payer-specific fee schedules loaded per contract, underpayments flagged, and disputes filed with the payer's contract compliance department. Underpayment disputes recover money that was billed, processed, and paid — just at the wrong amount.
Patient AR Management
Patient balance billing after insurance — statement generation, payment plan setup, patient follow-up calls, and financial hardship assessment before collection referral. Patient AR managed with the balance between revenue recovery and patient relationship preservation that a medical practice requires.
Previous Biller AR Recovery
Triage and recovery of inherited AR from previous billing relationships — claim status verification, denial identification, appeal filing on recoverable denials, and systematic cleanup of the backlog within timely filing deadlines.
Timely Filing Deadline Tracking
Every open claim tracked against its payer-specific timely filing deadline — claims approaching deadlines escalated for immediate action regardless of their position in the normal follow-up queue. No claim lost to timely filing because of a scheduling gap.
Payer Follow-Up Calls
Direct calls to payer claims departments for claims that have not adjudicated within standard timelines — reference numbers documented, expected resolution dates confirmed, and escalation to payer supervisors when standard follow-up produces no movement.
ERA and EOB Reconciliation
Electronic remittance advisories and paper EOBs reconciled against submitted claims — every line item verified, every adjustment categorized, every denial identified and routed to denial management. Clean posting is the foundation of accurate AR reporting.
AR Reporting and Analysis
Clear monthly AR reports — AR aging by payer, days in AR, collection rate by payer and by provider, write-off rate by reason, and underpayment recovery. Every number explained, every trend identified, every action item documented.
Clearinghouse Rejection Management
Claims rejected at the clearinghouse before reaching the payer — identified within 24 hours, corrected, and resubmitted. Clearinghouse rejections are pre-payer errors that most practices do not systematically monitor — they sit in the clearinghouse queue until the practice notices the claim never paid.
Unpaid claims often require more than routine follow-up, especially when a payer has issued a denial. Our denial management process helps identify the reason for the denial, coordinate the appropriate response, and pursue recoverable revenue before claims become too old to collect.
AR FOLLOW-UP PROCESS EXPLAINED
How Systematic AR Follow-Up Works — The Process Behind the Numbers
Day 1–14 (Electronic payers):
Claim submitted. Clearinghouse acknowledgment confirmed. Claim in payer adjudication queue.
Day 14–21:
ERA or EOB checked. If paid — payment posted and verified against contracted rate. If denied — denial categorized and response initiated within 48 hours. If pending — payer portal status checked.
Day 21–30:
Unpaid claims without ERA or denial follow-up initiated — payer portal check, EDI status inquiry, or direct payer call depending on payer preference.
Day 30–45:
All unpaid claims at 30+ days actively worked — follow-up call to payer claims department, reference number obtained, resolution timeline confirmed.
Day 45–60:
Escalation for claims with no movement after standard follow-up — payer supervisor contact, written inquiry, or second-level escalation.
Day 60–90:
High-priority resolution — claims approaching timely filing deadlines escalated immediately. Appeal filed if denial received. Corrected claim resubmitted if error identified.
Day 90+:
Write-off assessment — every claim assessed for recoverability before write-off. Write-off requires documented work attempts and specific non-recovery justification. No claim written off without a record.
UNDERPAYMENT IDENTIFICATION
Underpayments — The Revenue Your Practice Is Losing Without Knowing It
How underpayments happen:
- Payer applies wrong fee schedule (old contract rate instead of current negotiated rate)
- Payer applies wrong patient classification (HMO rate instead of PPO rate)
- Payer bundles multiple services that should be separately paid
- Payer applies incorrect multiple procedure reduction
- Payer applies incorrect modifier interpretation
- Payer processing error on a specific claim type
Why underpayments go undetected:
The claim paid. It did not deny. It did not create a work item. The payment posts to the account and the AR item closes. Nobody reviews whether the payment amount matches the contracted rate because that comparison requires knowing the contracted rate for every payer for every CPT code — a level of data management most practices do not have.
What underpayment recovery looks like:
Contracted rates loaded per payer per CPT code. Every payment compared against the rate. Variance identified and flagged. Dispute filed with the payer's contract compliance or provider relations department. Recovery timeline: 30–90 days per dispute. Recovery rate: high for clear rate discrepancies with contract documentation.
What we do:
Load contracted rates for every payer at the start of every client engagement. Compare every posted payment against contracted rates. Flag every underpayment above a defined threshold. File disputes for recoverable underpayments. Report underpayment patterns monthly — because a systematic underpayment from one payer on one CPT code may indicate a contract interpretation dispute that requires a higher-level resolution.
DAYS IN AR BENCHMARK
What Your Days in AR Should Be — And What It Means When It Is Not
Specialty
Good
Acceptable
Problem
Primary Care
Under 30
30–40
Over 40
Internal Medicine
Under 32
32–42
Over 42
Urgent Care
Under 28
28–38
Over 38
Cardiology
Under 38
38–48
Over 48
Orthopedics
Under 38
38–50
Over 50
Mental Health
Under 35
35–50
Over 50
Physical Therapy
Under 30
30–40
Over 40
What drives high days in AR:
- Slow claim submission (more than 48 hours after encounter)
- High first-pass denial rate (claims that deny and sit)
- No systematic AR follow-up process
- Payer mix heavy in slow-paying payers (Medicaid, workers comp)
- Patient AR not systematically collected
What we target:
Accounts receivable performance is closely connected to every stage of the RCM process. From timely claim submission and accurate payment posting to denial follow-up and collections, each step affects how quickly a practice converts billed services into collected revenue.
WHO WE SERVE
Who We Help With AR Management
Practices with bloated AR aging — systematic recovery before timely filing deadlines close the window
Practices changing billing companies — inherited AR triage and recovery from previous biller
High-volume practices — AR management at scale without the bottleneck of in-house follow-up capacity
Practices with high write-off rates — write-off audit and recovery of claims written off without documented work attempts
Multi-payer practices — payer-specific follow-up strategies for complex commercial, Medicare, Medicaid, and WC payer mixes
FAQ
Accounts Receivable Questions
How do you prioritize which AR claims to work first?
Can you recover AR from a previous billing company?
How do you handle patient AR differently from insurance AR?
What is your target for days in AR?
How do you identify underpayments?
Netix runs systematic, deadline-aware AR follow-up on every open claim — built on accurate medical billing and coding from day one. Contracted rates loaded per payer. Every posted payment compared against the contracted rate. Variances above a threshold flagged and disputed. We report underpayment recovery separately in the monthly AR report so you see exactly how much was recovered from payers who paid below contract.
What do you do when a claim truly cannot be recovered?
Can you recover AR from a previous billing company?
📞 +1 (307) 443-6706
✉️ info@netixmedicalbilling.com