Accounts receivable follow-up is the work of chasing every claim your practice has submitted that the payer has not paid. When nobody owns it, claims sit in the aging report until they are too old to fix easily.
Most practices notice the problem late. Deposits look acceptable, the schedule is full, and the claims still waiting on a payer are easy to ignore. By the time someone opens the aging report, a claim that needed one phone call at 30 days now needs an appeal at 90.
This accounts receivable follow-up guide explains why claims age, what to do in each aging bucket, and how to build a weekly follow-up routine that your team can actually keep up with.
Why claims age in accounts receivable
Claims rarely age because of one big failure. They age because small gaps have no owner.
- No assigned owner. Billing assumes the front desk will call. The front desk assumes billing is tracking it.
- No follow-up date. Staff submit a claim, and nothing in the workflow says when to check it again.
- Payer status is unclear. The payer received the claim, but nobody confirmed whether it is pending, in review, or denied.
- Missing information. The payer requested records, a corrected claim, or a prior authorization number, and the request sat in a portal inbox.
- Denials without a plan. Staff post a denial, but no one decides whether to correct, appeal, or write it off.
- Patient balances mixed in. Insurance follow-up and patient statements compete for the same hours, and insurance work slips.
Each of these is a process problem, not a payer problem. That is good news, because you can fix process problems.
Accounts receivable follow-up by aging bucket
An aging report groups unpaid claims by how long they have been outstanding. Each bucket calls for a different kind of work, and the oldest claims deserve attention first because they have the least time left.
| Bucket | What it usually means | What to do |
|---|---|---|
| 0–30 days | Normal processing time | Confirm the payer received the claim. Check status once, around day 14 to 21. Fix any rejection right away. |
| 31–60 days | Payer is slow or has a question | Call or use the payer portal. Ask for the exact claim status, any pending request, and a reference number. |
| 61–90 days | Likely stuck, denied, or missing information | Send what the payer requested, submit a corrected claim if needed, or begin the appeal. Note the filing deadline. |
| 90+ days | At risk of timely filing or appeal limits | Escalate to a senior biller. Decide whether to appeal, resubmit, or write off, and record the reason. |
Timely filing and appeal windows vary by payer and plan. Medicare fee-for-service claims, for example, generally must be filed within 12 months of the date of service, and other payers set their own limits. Check each payer’s published limits and put the deadline on the claim note so the date does not depend on memory.
A weekly accounts receivable follow-up workflow
A short, repeatable routine works better than an occasional cleanup. This one fits into a few focused hours each week.
- Run the aging report. Pull unpaid insurance claims by payer and by bucket. Keep patient balances on a separate report.
- Sort oldest first. Start with 90+ days, then 61–90, then 31–60.
- Work by payer. Handling one payer at a time saves time because the portal, phone tree, and requirements are the same.
- Check status and act. Resubmit, send records, correct the claim, or open an appeal. Do not just note that it is still pending.
- Set the next follow-up date. Every claim you touch leaves with a date for the next check.
- Flag patterns. If the same payer, code, or provider keeps showing up, send the pattern back to the front desk, coding, or the provider.
- Review the totals. Track how much was collected from each bucket and which claims moved out of 90+, and compare it with your monthly revenue cycle KPIs.
The last two steps matter most. Follow-up that never feeds back into front-end work keeps producing the same aging claims.
What to document on every follow-up
Good notes make accounts receivable follow-up faster, because a second call becomes a short call. Whoever picks up the claim next, including you in three weeks, should not have to start over. Record these items each time:
- Date and method of contact (portal, phone, or fax)
- Name of the payer representative, if you spoke with one
- Call or reference number
- Exact claim status the payer gave you
- What the payer needs from you, and by when
- What you did in response
- The next follow-up date
Avoid vague notes such as “called payer, pending.” They record effort but not progress.
When to escalate, appeal, or write off
Not every old claim is worth the same effort. A simple decision rule keeps the team from spending hours on low-value balances or giving up on claims the payer denied in error.
- Correct and resubmit when the denial came from a fixable error, such as a wrong code, missing modifier, or incorrect patient data.
- Appeal when the service was covered, the documentation supports it, and the denial reason is disputed. Our behavioral health claim denial appeal guide shows how to structure the response.
- Escalate when a payer repeatedly gives conflicting answers, a large balance is at risk, or the filing deadline is close.
- Transfer to patient responsibility only after the payer has processed the claim and the balance is truly the patient’s.
- Write off when the claim cannot be corrected, appeal rights have expired, or the cost of continued work exceeds the balance. Document the reason and get approval according to your practice policy.
If the same denial reasons keep coming back, follow-up alone will not solve it. Our post on how to measure and reduce your claim denial rate covers prevention.
Keeping accounts receivable follow-up in-house or getting support
Many small practices can run this routine themselves if one person has the time, the payer knowledge, and clear ownership. Trouble starts when follow-up is squeezed between check-in, phone calls, and patient questions. In that case the aging report only gets attention when cash flow tightens.
If that sounds familiar, these are the signs that outside support may help:
- Claims over 60 days are growing from month to month
- No one can say who owns each unpaid claim
- Follow-up notes are missing or inconsistent
- The same payers and denial reasons keep repeating
- Staff turnover has left gaps in payer knowledge
Capitol Medical Technologies supports independent practices with medical billing and revenue cycle management and denial management, including claim follow-up. For a cost comparison, see our guide to in-house vs. outsourced medical billing.
Want a second set of eyes on your aging report? Request a free revenue review and our team will walk through where your unpaid claims are stuck.