We work every open claim and balance to zero inside the EHR you already use: payer follow-up, underpayment checks and old A/R cleanup, each with an owner and a deadline.
Quick answer
Accounts receivable management services work every unpaid claim and balance until it is paid, adjusted or written off with a reason. That means aging reports, payer follow-up, denial and appeal work, underpayment checks, legacy A/R cleanup and patient balance follow-up, each with a named owner and a deadline.
Accounts receivable management services keep every unpaid claim and patient balance moving until it is paid, adjusted or written off for a documented reason. Billing creates the claim. A/R management starts after it is sent and ends when the balance reaches zero.
You may know it as medical A/R recovery services or A/R follow-up for medical practices. It is the same work, and we do it inside the EHR you already use.
See what is sitting in your A/R
Our free audit reviews your aging report, sample denials and remittances, and who owns each queue.
A/R ages when claims are denied, short-paid or never followed up. Much of that money is still payable, but only if someone works it before a deadline passes.
In Premier's survey published in February 2025, hospitals and health systems reported a denial rate of nearly 15% on their 2023 claims. Fighting a denial cost an average of $57.23 per claim, and about 70% of denials were ultimately overturned and paid. These are hospital figures, so read them as a signal, not a benchmark for a physician group.
KFF's analysis of 2024 HealthCare.gov marketplace data, published in March 2026, found that fewer than 1% of denied claims were appealed, and insurers upheld 66% of the appeals that were filed. Marketplace plans are one payer type, but the gap is clear.
In practice, A/R sticks with claims nobody checks, denials nobody owns and short payments nobody compares with the contract.
Aging buckets group unpaid balances by how long they have been open. Days in A/R converts the open balance into days of charges or revenue. Use a published definition so the number means the same every month.
HFMA's MAP Keys (2023 edition) define aged A/R as the billed A/R in each bucket divided by total billed A/R. The buckets are 0 to 30, 31 to 60, 61 to 90, 91 to 120 and over 120 days, aged from the date of service for physician claims.
For days in A/R, MGMA's data definitions give days of adjusted fee-for-service charges in A/R as total A/R divided by daily adjusted FFS charges (adjusted FFS charges times 1/365). HFMA's net days in A/R (key FM-1) uses a different base: net A/R divided by average daily net patient service revenue over the most recent three months.
Buckets also show how close a claim is to a filing deadline. For more on the metrics, see our guide to A/R report metrics and our accounts receivable guide.
Organize follow-up by next deadline and dollar value, and give every claim one named owner for its next action. Cadence differs by payer, so we set it from each payer's processing window and your contract.
In the RCM Finder portal, each claim sits in a named stage, and workflow rules flag a claim for review, hold or advance it, or assign an owner. Our team works inside your existing EHR (for example PrognoCIS, eClinicalWorks or athenahealth).
The 2024 CAQH Index (calendar-year 2023 data) put provider labor cost at $13.80 for a manual claim status inquiry versus $3.64 electronically. We use electronic checks where a payer offers them.
Filing and appeal deadlines decide it. For Original Medicare, a claim must be filed within one calendar year after the date of service, and a denial can be appealed through five levels, each with its own clock.
| Step | Who decides | Time limit to act | Decision time |
|---|---|---|---|
| Claim filing | Medicare contractor | 1 calendar year after date of service; limited exceptions | Not applicable |
| 1. Redetermination | Medicare Administrative Contractor | 120 days from receipt of the initial determination (receipt presumed 5 days after notice) | Generally 60 days |
| 2. Reconsideration | Qualified Independent Contractor | 180 days from receipt of the redetermination notice | Generally 60 days |
| 3. Hearing | OMHA (administrative law judge) | 60 days from receipt of the reconsideration decision; minimum amount in controversy ($200 in 2026) | 90 days |
| 4. Council review | Medicare Appeals Council | 60 days from receipt of the hearing decision | 90 days |
| 5. Federal court | U.S. District Court | 60 days from receipt of the Council decision; minimum amount in controversy ($1,960 in 2026) | Not specified |
Sources: 42 CFR 424.44, eCFR (2026); CMS Medicare FFS appeals flowchart (2026 amounts in controversy); CMS MLN, Medicare Parts A and B appeals process. Receipt is presumed 5 days after the notice date. Medicare Advantage and commercial plans set their own deadlines in the plan rules and your contract.
Other payers set their own limits. We load each payer's windows into the work queue. For state-specific limits, start with our medical billing time limits guide and confirm against your contract.
For uninsured or self-pay patients, 45 CFR 149.610 requires a good faith estimate within 1 business day of scheduling when the service is booked at least 3 business days ahead, and within 3 business days when it is booked at least 10 business days ahead or the patient asks. CMS explains that a bill at least $400 above the estimate can go to patient-provider dispute resolution. Build estimates into scheduling.
Size the gap before the audit
Enter your monthly claim volume and collections in our revenue calculator to estimate what slow A/R costs you.
An underpayment is a claim paid below what your contract or fee schedule says. It only shows up if each payment is compared with an expected amount. Legacy cleanup applies the same discipline to old balances.
Share your contracted rates or fee schedules. The portal compares each paid amount with the expected amount and flags the variance for review. Not every gap is an error. Reason code 45 means, per X12, that the charge exceeded the fee schedule, maximum allowable or contracted fee, so we confirm that adjustment matches your contract.
See our legacy A/R guide and A/R recovery tips for small practices. Some old claims will be past their deadlines. We tell you which early.
We start with a free audit, then take over the queues in stages, inside your existing EHR. You keep your system and your data.
We review your aging report, a sample of denials and remittances, and who owns each queue. You get a written summary of where A/R is stuck. Pricing is quoted after the audit.
We put a Business Associate Agreement in place before accessing patient data, then set role-based access.
We record each payer's filing and appeal windows and your expected amounts.
Our team works in your EHR. Every claim sits in a named portal stage with an owner. Your time zone governs every shift.
Status checks, denial corrections, appeals and underpayment disputes, ordered by deadline and dollars at risk.
Weekly KPI reporting, or on your schedule on aging and days in A/R, plus a review of why claims stalled. Each repeat cause gets an owner.
We build our billing pipeline around how claims actually move through a practice: registration, charge entry, submission, payment and follow-up.
The queues are the same in every specialty. What stalls in them is not.
| Specialty group | What changes in A/R work | What we check first |
|---|---|---|
| Pain management | High-value procedure claims with authorization and medical-necessity edits. Same-day visit plus procedure raises modifier 25 questions. One Medicare Part B jurisdiction's epidural steroid injection LCD (L39240, April 2026) ties repeat injections to documented improvement. | Denial reason, authorization on file, documentation for repeats |
| Cardiology | Many services split into professional and technical parts, so a partial payment may be correct or short. | Which component was paid, and against which expected amount |
| Orthopedics | Surgical claims sit inside global periods (000, 010 and 090 days in the NCCI manual), so a denial can be a global-package rule, not a payer error. | Whether the visit falls inside a global period before disputing |
| Oncology | High-value drug claims and frequent secondary coverage, so a primary payment is not the end. | Secondary billing after primary payment; payment against expected amount |
| Behavioral health | Time-based codes, telehealth modifiers and many small patient balances. A code that does not match its modifier is a recognized denial reason (code 4). | Modifier-to-code match; patient balance follow-up |
| Radiology | Claims depend on order and patient data created elsewhere, so a missing ordering provider stalls payment. | Ordering provider, order on file, demographics |
| Dermatology | Insured care plus self-pay services. A visit on the day of a minor procedure needs a clear reason for modifier 25. | Modifier 25 support; estimate delivered and kept on file |
Sources: CMS NCCI Policy Manual, Chapter 1 (2026); Noridian article for LCD L39240 (effective April 9, 2026); X12 claim adjustment reason codes; 45 CFR 149.610. Other cells describe operating logic, not statistics.
Start from our specialty RCM hub to find your specialty's page.
A/R problems are usually created earlier. We run A/R management as one part of four connected services.
Marketing decides which plans reach your schedule. Slow-paying plans show up in aging first.
Many aging claims began with a wrong member ID or missing authorization. Our assistants handle scheduling, eligibility, prior authorizations and intake.
Coding support, claim scrubbing, denial management and A/R follow-up run by one accountable team.
The portal shows where each claim stands and who owns the next step, for practices and billing companies.
Choose the model that can work every open claim before its deadline. In-house gives control, outsourced adds capacity, and a hybrid splits the queues.
| Factor | In-house | Outsourced | Hybrid |
|---|---|---|---|
| Control of each queue | Highest | Set by scope and reporting | Split by queue |
| Coverage when the biller is out | Gaps unless cross-trained | Vendor covers absences | Partner covers its queues |
| Old A/R backlog | Competes with daily work | Can be worked as a project | Partner takes the backlog |
| Cost structure | Salaries, benefits, software, training | Contract fee (ours quoted after a free audit) | A mix of both |
| Usually suits | Larger groups with stable billing staff | Practices with aging A/R and thin staff | Practices keeping patient calls in-house |
Decision guide based on common operating models; no sourced statistics.
Ask two questions. Can your team work every denial before its appeal deadline? Who covers A/R when your biller is out? See also how front desk staff affect the revenue cycle.
Not sure which model fits?
Talk it through with our team. If keeping A/R in-house makes more sense for your practice, we will say so.
Any company that works your claims is a HIPAA business associate and must sign a Business Associate Agreement. Beyond that, ask who works your queues.
HHS guidance lists billing and claims processing as business associate functions and says a business associate is directly liable for certain HIPAA provisions. The minimum necessary standard limits patient data use to what a task needs, and the Security Rule's technical safeguards (45 CFR 164.312) include access control, audit controls and transmission security.
Our setup: role-based access, audit logging, encrypted HTTPS connections, and a Business Associate Agreement before we access patient data. For your side, use our HIPAA compliance checklist.
We would rather tell you now than after you sign. Here is where we fit and where we do not.
A good fit if you are
Probably not a fit if you are
What we would do first if we were running your practice's revenue cycle tomorrow.
We sort open claims by nearest filing or appeal deadline, then by dollars. A younger claim near a deadline can matter more than an older one with time left.
A claim with two owners has none. We assign a name and a next-action date to each.
Underpayments cannot be found without an expected amount. Share your fee schedules.
Agree who approves a write-off and which reasons are allowed, or the cleanup becomes unexplained adjustments.
Overpayments have their own deadline. We list credit balances so refunds do not sit in A/R.
They are the follow-up work that starts once a claim is sent and ends when the balance is paid, adjusted or written off with a reason. That includes aging review, payer status checks, denial and appeal work, underpayment review, legacy A/R cleanup and patient balance follow-up. Billing creates the claim. A/R management makes sure it is collected, and shows you where it is stuck when it is not.
It depends on the definition. MGMA's data definitions give days of adjusted fee-for-service charges in A/R as total A/R divided by daily adjusted FFS charges (adjusted FFS charges times 1/365). HFMA's net days in A/R divides net A/R by average daily net patient service revenue over the latest three months. The two will not match, so choose one and keep it.
Under 42 CFR 424.44, a Medicare claim must generally be filed within one calendar year after the date of service, with limited exceptions. A first-level appeal (redetermination) is due within 120 days of receiving the initial determination. Medicare Advantage and commercial plans set their own limits, so check the plan rules and your contract. We load each payer's window into the work queue.
Yes. We pull the aged trial balance, separate claims past a filing or appeal deadline from those still open, and work the recoverable ones by dollar value and deadline. Some older claims will no longer be collectible, and we tell you which ones early so nobody spends time on them and the recoverable money is worked first.
You share your contracted rates or fee schedules. The portal compares each paid amount with the expected amount and flags the difference for a person to review. We check the remittance first, because some differences are correct adjustments. Confirmed short payments are then disputed with the payer. Without an expected amount, underpayments cannot be found, so the fee schedule is the first thing we ask for.
Pricing depends on claim volume, specialty, payer mix and the size of any old A/R backlog. We quote after a free practice audit so the price reflects your real workload. Whoever you choose, ask what is included, such as old A/R, patient balances, low-dollar claims and reporting.
Tell us about your practice. A member of our operations team replies within one business day.
Pricing is quoted after the audit, based on your volume and the services you choose. Prefer to talk? Call +1 (302) 556-2288.
Tell us about your practice
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