When A/R recovery services make sense
Fastora’s A/R recovery services treat an old accounts receivable backlog as a defined project, with an agreed scope, a deadline-first work plan and a close-out report. Certified medical billing professionals sort what can still be collected, work it with each payer, and document what cannot. Size the problem with our AR aging calculator.
The most common case is legacy A/R recovery when switching billing companies. The outgoing vendor stops working claims on its last day, and balances from the final months are left with no owner. Our guide to changing billing vendors covers the handoff steps that protect those claims.
Other triggers look similar: a biller leaves and nobody picks up follow-up, a practice management system conversion leaves claims stranded in the old system, or a credentialing gap produces a batch of denials that were never reworked. In each case the old balances need research before anyone calls a payer.
How old A/R recovery differs from ongoing A/R management
Ongoing A/R management and insurance follow-up is a routine: every new claim is tracked from submission to payment, month after month. Old accounts receivable recovery for medical practices is a one-time project aimed at balances that already fell behind.
The two can run side by side. Keeping them separate matters, because a backlog project has its own inventory, its own priorities and its own reporting. If both are mixed into one queue, staff tend to chase the oldest balances and let this month’s claims slip, which simply creates the next backlog.
What we can still recover
Not every old balance is collectible, and saying so early is part of the job. Whether a claim can still be paid depends mostly on where it sits against the payer’s deadlines and what records exist.
| Claim situation | Usual outlook | What we do |
|---|---|---|
| Rejected at the clearinghouse and never accepted, still inside the filing limit | Often recoverable | Fix the rejection reason and submit the claim |
| Denied, and the payer’s appeal or reconsideration window is still open | Often recoverable | Correct the claim or appeal with the records that answer the denial |
| Denied for late filing, but an acceptance report shows it was filed on time | Possible | Request reconsideration with the proof of timely filing |
| Medicare claim with a clerical error | Possible within the reopening window | Request a reopening instead of a formal appeal |
| Paid below the contracted rate | Possible within the contract’s dispute period | Dispute the payment with the fee schedule |
| Past the filing and appeal windows with no proof of timely filing | Usually not recoverable | Document the reason and recommend an adjustment |
Timely filing and appeal windows
Medicare generally requires claims to be filed within 12 months of the date of service under 42 CFR 424.44, which lists limited exceptions such as an administrative error by Medicare or its contractor. After an initial determination, a provider has 120 days from receipt to request a redetermination. Medicare contractors can also reopen a determination within one year for any reason and within four years for good cause, according to CMS’s claims processing manual.
Commercial and Medicaid limits are set by contract, plan and state, and many are shorter than Medicare’s. We record each payer’s filing and appeal limits from your contracts and the payer’s own published material, and you should check your contract for the exact terms. Our article on payer filing deadlines explains how these limits are counted.
How the aged A/R cleanup project works
An aged A/R cleanup starts with data, not phone calls. Fastora signs a Business Associate Agreement before accessing PHI, then works inside your existing systems under the user access you grant, including read access to the old system if the claims live there.
- Inventory: export open A/R, remittance history and clearinghouse reports, then confirm the backlog by payer, date of service, status and balance.
- Triage: sort claims by time left on the filing or appeal deadline, then by balance, so the claims closest to expiring are worked first.
- Research: check claim status with the payer, read the denial reason codes and review any notes or appeal copies the previous biller left.
- Resolve: submit, correct, request reconsideration or appeal, depending on what the payer did with the claim.
- Close out: balances with no remaining path are documented with the reason and a recommended adjustment for your approval.
Triage by age and payer
Age alone can mislead. A 200-day-old commercial claim may already be past a short filing limit, while an older Medicare claim might still be inside an appeal window. That is why we rank by the time left on each payer’s deadline first, then group work by payer so one payer call or portal session can cover several claims.
Patterns found during triage are fixed before claims are resubmitted. A batch of enrollment denials, for example, points to a provider who was never linked to the group with that payer, and resubmitting before payer enrollment is corrected only produces the same denial again. Denials that need written appeals are handled with our denial and appeals team.
Reporting on a medical A/R cleanup
A medical A/R cleanup should end with a clear record, not a vague sense that old claims were handled. Project reporting sits next to Fastora’s monthly performance reporting and review call, and transparent dashboards show progress between calls.
- The starting inventory by payer and aging bucket
- Claims worked, resubmitted, appealed and still pending
- Payments received on project balances
- Balances closed as not recoverable, grouped by reason
- Patterns found, such as enrollment or coding issues, and the fix for each
The close-out reasons are often the most useful part. They show which upstream problems created the backlog, so the same losses do not repeat once the project ends.
Pricing for an A/R backlog cleanup
An A/R backlog cleanup is quoted after the free assessment, once the size and age of the backlog are known. Fastora may offer a percentage of collections, a flat fee per claim or a hybrid, depending on scope. A percentage-of-collections arrangement on a cleanup project is often called contingency pricing, because the fee depends on what is actually collected.
There are no hidden setup fees and no software to install. See how our pricing models work, or start with a free billing assessment that sizes your old balances before you commit to anything. The project can also be the first step toward full-service billing support.
Unpaid claims recovery services
Our unpaid claims recovery services work the A/R most teams have given up on: claims over 90, 120, and 180 days, each one checked for timely filing limits before any work is spent. Every claim is categorized — payable with a correction, payable on appeal, underpaid against contract, or a write-off that needs your approval — and worked through the right route. An aged AR recovery company should report recoveries separately from current collections, so you can see exactly what the cleanup returned versus what the ongoing cycle collects. Our A/R management service keeps the current aging from becoming the next cleanup, our denial management service works the denial root causes, try the revenue leak calculator to size what aging A/R may be costing.