Submitting a medical claim is only one step in getting paid.
For many healthcare practices, the real work begins after the claim has been submitted. Some claims are paid quickly, while others remain unresolved for weeks or months. Without consistent follow-up, aging accounts can become increasingly difficult to collect.
This is where accounts receivable follow-up in medical billing becomes essential.
A strong A/R process gives practices a structured way to monitor unpaid claims, determine why money remains outstanding, and take appropriate action. It can also help billing teams spend their time more efficiently instead of treating every outstanding account exactly the same way.
What Is A/R in Medical Billing?
Accounts receivable, commonly called A/R, represents money that is owed to a medical practice.
In healthcare, this can include outstanding balances from insurance companies as well as amounts owed by patients.
A/R is not necessarily a sign that something has gone wrong. Insurance claims can take time to process, and patient balances may not be due immediately.
The concern arises when accounts remain unresolved for extended periods without a clear reason or follow-up strategy.
The longer an account sits without appropriate action, the greater the risk that the practice will have difficulty collecting the money it is owed.
Why A/R Follow-Up Matters
A practice can submit accurate claims and still experience cash flow problems if unpaid accounts are not actively managed.
A/R follow-up helps answer important questions:
- Was the claim received by the payer?
- Has it been processed?
- Was payment issued?
- Was the claim denied?
- Is additional information required?
- Was the claim sent to the wrong payer?
- Is the balance actually the patient’s responsibility?
- Does the account require an appeal or correction?
- Has the payer exceeded its expected processing timeframe?
Without answers to these questions, outstanding balances can simply accumulate.
Not Every A/R Account Should Be Treated the Same
One of the biggest challenges in A/R management is volume.
A busy practice may have hundreds or thousands of outstanding accounts. Trying to work every account in the same order can consume significant staff time without producing the best results.
Instead, practices can segment A/R according to factors such as:
- Age of the balance
- Dollar amount
- Payer
- Claim status
- Type of service
- Patient responsibility
- Previous follow-up activity
- Likelihood of successful recovery
This creates a more organized approach to account management.
Understanding A/R Aging
A/R aging reports typically divide outstanding balances according to how long they have remained unpaid.
Common categories include:
- 0 to 30 days
- 31 to 60 days
- 61 to 90 days
- 91 to 120 days
- More than 120 days
The exact categories can vary by practice and billing system.
The purpose is to identify how long money has been outstanding and determine which accounts may require attention.
A relatively new claim may simply be within the payer’s normal processing timeframe.
An account that has remained unresolved for several months may require a much more active investigation.
Start With the Reason, Not Just the Age
Age is useful, but it does not explain why an account remains unpaid.
Consider two claims that are both 90 days old.
The first may have been submitted correctly and still be awaiting payer processing.
The second may have been denied because required information was missing.
They are the same age, but they require completely different actions.
This is why effective A/R follow-up combines aging information with claim status and account history.
Common Reasons Claims Remain in A/R
Outstanding claims can result from many different circumstances.
The Payer Has Not Processed the Claim
Sometimes the claim has been received but has not yet been adjudicated.
The billing team may need to monitor the claim and follow up if it exceeds the expected processing period.
The Claim Was Denied
A denial requires investigation.
The team needs to understand the reason for denial and determine whether the claim can be corrected, appealed, or otherwise resolved.
Additional Information Is Required
A payer may request documentation or other information before completing processing.
If the request is not addressed, the claim may remain unresolved.
The Claim Was Sent to the Wrong Payer
Incorrect payer information can result in delays and additional administrative work.
The practice may need to correct the information and submit the claim to the appropriate insurance company.
The Balance Is Patient Responsibility
Not every outstanding balance is an insurance issue.
After insurance processes a claim, some portion may legitimately become the patient’s responsibility.
That balance then needs to move into the appropriate patient billing and collection workflow.
A/R Follow-Up Should Be Documented
A phone call or electronic inquiry should not disappear into someone’s memory.
Billing teams should maintain appropriate documentation of follow-up activity.
Depending on the practice’s systems and procedures, this may include:
- Date of follow-up
- Payer contacted
- Representative or department contacted
- Claim status
- Information provided
- Reference number
- Expected next step
- Follow-up date
- Appeal or correction status
Good documentation makes future follow-up easier and reduces the likelihood that staff will repeat the same work unnecessarily.
Payer-Specific Patterns Can Reveal Problems
A/R reports can provide more information than simply showing how much money is outstanding.
They can also reveal patterns.
For example, a practice may discover that claims from one payer consistently take longer to process. Another payer may generate recurring requests for additional documentation. A particular type of claim may frequently require correction.
These patterns can help leadership determine where additional training, workflow changes, or payer-specific procedures may be useful.
The goal is to move from simply working accounts to understanding why accounts become difficult to collect.
High-Dollar Claims Deserve Attention
A $25 outstanding balance and a $2,500 outstanding claim may require different levels of attention.
High-dollar accounts can have a significant effect on cash flow, particularly for smaller medical practices.
This does not mean lower-dollar accounts should automatically be ignored. Rather, practices can establish reasonable prioritization rules that allow staff to focus attention where it may have the greatest financial impact.
What Happens When A/R Gets Too Old?
As accounts age, collection can become more challenging.
Older claims may involve:
- Missing documentation
- Difficult-to-locate records
- Staff turnover
- Outdated payer information
- Filing deadline concerns
- Multiple previous follow-ups
- Patient contact difficulties
- Unclear account history
This is why practices should not wait until balances become severely aged before investigating them.
Early and consistent follow-up gives the practice more opportunities to resolve problems while the relevant information is still accessible.
A Practical A/R Follow-Up Workflow
A structured workflow can make the process easier to manage.
Step 1: Review the A/R Report
Identify outstanding balances and their aging categories.
Step 2: Segment the Accounts
Group accounts by payer, age, balance, claim status, or other relevant criteria.
Step 3: Investigate the Status
Determine whether the claim is pending, denied, under review, awaiting information, or otherwise unresolved.
Step 4: Take the Appropriate Action
Depending on the situation, this could mean correcting a claim, submitting documentation, appealing a denial, contacting the payer, or billing the patient.
Step 5: Document the Activity
Record what happened and what needs to happen next.
Step 6: Set a Follow-Up Date
An account should not simply be returned to the general A/R list without a clear next step.
Step 7: Review Recurring Patterns
Regularly analyze the A/R data to identify problems that may be occurring repeatedly.
This workflow creates accountability while giving billing staff a clear path for handling outstanding accounts.
How Practices Can Improve A/R Performance
A/R management is not only about working older claims.
Practices can also improve performance by examining the processes that create A/R in the first place.
This may involve reviewing:
- Claim submission accuracy
- Patient registration procedures
- Documentation workflows
- Billing turnaround times
- Payment posting
- Patient statements
- Follow-up frequency
- Staff responsibilities
- Billing system reports
If the same problem repeatedly creates outstanding balances, solving the root cause may be more valuable than continually correcting individual accounts.
When Should a Practice Consider Outside Support?
A practice may benefit from additional billing support when its internal team does not have enough time or resources to maintain consistent A/R follow-up.
This can happen as patient volume grows, new providers join the practice, billing becomes more complex, or administrative responsibilities begin competing with other priorities.
Outside billing professionals can provide dedicated attention to outstanding claims and help practices establish more organized financial workflows.
How Billing Nerds Supports Medical Practices
Billing Nerds provides medical billing and consulting services for healthcare practices that need support managing the financial side of their operations.
Our services include Medical Billing, Documentation Review, Patient Statements, Insurance Credentialing, Business Consulting, and Strategy & Marketing.
A structured approach to A/R can help practices understand what is outstanding, why it remains unpaid, and what action should happen next.
For practices that are struggling with aging accounts, inconsistent follow-up, or limited internal billing resources, professional support can provide another layer of organization and oversight.
Conclusion
Accounts receivable is an unavoidable part of medical practice operations, but unmanaged A/R can become a serious financial burden.
The solution is not simply to make more phone calls.
Effective A/R follow-up requires prioritization, documentation, timely action, and an understanding of why individual accounts remain unresolved.
When practices treat A/R as an active process rather than a report that gets reviewed occasionally, they gain better visibility into outstanding revenue and the obstacles preventing collection.
Every unpaid claim has a story behind it.
The job of an effective billing process is to find that story, determine what needs to happen next, and keep the account moving toward resolution.
Author: Rhonda Scantlebury