Old accounts receivable doesn’t age gracefully. A claim at 30 days is a follow-up task; the same claim at 180 days is a project. Here’s a practical playbook for working aged claims — whether you handle it in-house or decide it’s time to hand it to someone who does this full-time.
Step 1: Sort by age bucket, not by total
Don’t look at the total first. Break A/R into 0–30, 31–60, 61–90, 91–120, and 120+ day buckets. The 120+ bucket is where this playbook lives.
Claims past 120 days need a different workflow than current A/R. They’re closer to timely filing deadlines, appeal windows may have closed, the documentation trail is colder, and the original billing staff may not remember the details. Treating a 150-day claim like a 30-day claim — a quick follow-up call — wastes the effort. It needs investigation, not just a nudge.
Start by pulling an A/R aging report grouped by these buckets. If your system can’t produce one, that’s itself a finding: you can’t work what you can’t see.
Step 2: Separate the collectable from the uncollectable
Not every old claim is worth working. Before spending hours, sort each aged claim into one of three piles:
Collectable: Denied for a fixable reason (missing authorization that can be obtained retroactively, coding error that can be corrected and resubmitted, eligibility issue resolved by updated information). Underpaid against contract terms. Or never followed up at all — still within filing and appeal windows, just ignored. These get worked.
Appealable: Past the first denial but inside the appeal window, with a defensible argument. The payer’s reason doesn’t hold up against the documentation or the contract. These get appealed — formally, with the records attached, before the window closes.
Uncollectable: Past timely filing with no appeal rights remaining. Or the payer’s decision is final and correct — the service wasn’t covered, the contract excludes it, the documentation doesn’t support it. These get documented and written off — deliberately, with a reason recorded, not by neglect. Our guide to write-offs covers when each reason category justifies a write-off.
The point of this triage is focus. Most practices waste their oldest-A/R effort on claims that were never collectable while genuinely collectable claims sit untouched in the same bucket. An hour of triage saves ten hours of misdirected work.
Step 3: Work payer by payer, not claim by claim
Aged claims cluster by payer and by denial reason. Ten claims denied by the same payer for the same authorization issue are one problem with ten instances — work the pattern, not the claims individually.
Call the payer’s provider line with the batch. Resolve the root cause — the authorization requirement, the coding edit, the credentialing gap — then clear the batch against the resolution. This is dramatically faster than working ten claims as ten separate problems, and it prevents the next ten from denying the same way.
Document the pattern and the resolution. If the same payer denies the same way again next month, your front-end process should catch it before the claim goes out.
Step 4: Watch the clocks
Two deadlines matter most on old A/R: timely filing limits and appeal windows.
A claim approaching its filing deadline jumps to the front of the queue regardless of its dollar value. Once the deadline passes, the revenue is gone — no appeal, no correction, no recovery. Check your payer contracts for the specific limits; they vary by payer and by plan, and the contract governs.
Appeal windows are the second clock. A denial with a 180-day appeal window at day 170 is urgent; the same denial at day 60 can wait its turn. Sort your appealable pile by window remaining, not by claim age.
Step 5: Document the close-out
Every aged claim should end in one of two places: collected, or written off with a documented reason. “Aged out, no action taken” is not a close-out — it’s how the next A/R cleanup project gets created.
A clean close-out report tells you three things: what was recovered (dollars and claims), what was written off and why (by reason category), and what process change prevents the next backlog. That third item is the one most practices skip, and it’s the reason they run this playbook again in eighteen months.
When to hand it off
If the 120+ bucket keeps growing faster than your team works it down, the in-house workflow has hit its limit. That’s the point where a defined cleanup project — scoped, deadline-driven, with a close-out report — makes more sense than asking the same staff to do more of what’s already not working. That’s exactly what Old A/R Recovery Services are: a defined project for aged and legacy balances, not an open-ended billing arrangement.
The math is straightforward: compare the staff cost of working the backlog in-house (hours × loaded cost, plus the opportunity cost of what they’re not doing) against a project-based cleanup. If the backlog is large enough, the project pays for itself in recovered revenue alone.
Not sure how big the problem is? A free billing audit will size your 120+ bucket and show you what’s actually recoverable — and our guide to reduce days in A/R covers the front-end fixes that keep the bucket from refilling.
Frequently asked questions
How old is too old to work a claim?
It depends on the payer’s timely filing limit and appeal windows, which vary by contract. A claim past its filing deadline with no appeal rights is generally uncollectable. Check your specific payer contracts — never assume a universal deadline.
Should we work old A/R in-house or outsource it?
If the 120+ bucket is growing faster than your team clears it, or if working it pulls staff from current billing (creating new backlogs), a defined project usually makes sense. Small, stable backlogs can be worked in-house with the triage method above.
What’s the difference between old A/R recovery and underpayment recovery?
Old A/R recovery deals with claims that were never paid — denials, ignored follow-ups, aged balances. Underpayment recovery deals with claims that were paid but paid below the contracted rate. They’re different problems requiring different workflows.
How do we prevent the next A/R backlog?
Track uncoded encounters and aging buckets weekly, set thresholds that trigger action early, fix the root causes your close-out report identifies (usually front-end: verification, authorization, or coding), and review the trend monthly.
Is it worth working claims under a certain dollar amount?
Triage by deadline first, then by value. Low-dollar claims past their appeal windows are usually write-offs. But low-dollar claims inside their windows, worked as part of a payer batch, cost almost nothing incremental to include.
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