Every dollar sitting in your accounts receivable is a dollar your practice has already earned but hasn’t collected. The question is whether it ever will be. (Accounts Receivable Follow Up Services)
AR follow-up is the billing function that determines the answer. It is the systematic process of tracking every outstanding claim and patient balance across every payer, every age bucket, every follow-up cycle and taking specific action on every one until it is paid, appealed, or written off with a documented reason.
When AR follow-up is done correctly, your practice collects the overwhelming majority of what it bills, your cash flow is predictable, and your AR aging stays concentrated in the 0–60 day range where claims are still within payer response windows and timely filing safety margins. When it isn’t done correctly when follow-up is inconsistent, when aging claims go unworked, when patient balances sit without statements revenue walks out the door quietly. The claims don’t disappear from the system. They just age until they’re written off.
At Malakos Healthcare Solutions, we provide structured AR follow-up services built around a systematic 15/30/60-day follow-up cycle, payer-specific follow-up workflows, patient balance management, and AR performance analytics that give your practice full visibility into what it is owed and what is being done to collect it.
Why AR Follow-Up Determines Whether Revenue Gets Collected (Accounts Receivable Follow Up Services)
AR follow-up sits at the end of the billing cycle but it is not a residual or cleanup function. It is a primary revenue collection function that determines the final outcome of every claim your practice submits.
Clean claim submission improves your first-pass acceptance rate. Denial management recovers claims that were denied. But neither of those functions collects money from claims that are pending, delayed, under review, or sitting in a payer’s system without adjudication. That is what AR follow-up does.
The aging problem: Claims age from the date of service forward. Most payers have timely filing windows, prompt payment laws, and adjudication timelines that create real deadlines for AR action. A claim that’s 30 days outstanding with no response is simply pending standard payer turnaround. A claim that’s 90 days outstanding with no response is a problem. A claim that’s 120+ days outstanding is approaching write-off territory for many practices not because the money isn’t recoverable, but because no one followed up.
The payer behavior problem: Insurance companies do not follow up with providers when claims are pending. They adjudicate claims on their own timeline, and when there is a question missing information, processing hold, coordination of benefits issue, system error they frequently wait for the provider to inquire rather than proactively communicating the status. A practice that doesn’t follow up on aging claims is, in effect, letting payers hold its money indefinitely.
The volume problem: A busy practice submits hundreds of claims per week. At any given time, the AR queue contains weeks or months of outstanding claims across dozens of payers at different stages of adjudication. Without a structured, prioritized follow-up workflow one that ensures every claim in every aging bucket gets worked on a consistent schedule older claims get displaced by newer ones, and the AR ages by default.
AR Aging Buckets – How We Categorize and Work Outstanding Balances
AR aging is measured from the date of service (or in some workflows, the date of first billing) in standardized time buckets. The aging bucket a claim falls into determines the urgency and the nature of the follow-up action.
0-30 Days
Status: Claims submitted within the last 30 days. Most payers adjudicate clean claims within 14-30 days. Claims in this bucket that haven’t received a response are generally within normal processing timelines.
Follow-up action: Monitor. Confirm submission was received by the clearinghouse and transmitted to the payer. For electronic claims, verify ERA or EOB is expected. No active payer outreach typically required unless the claim shows as unacknowledged at the clearinghouse level.
Flag criteria: Claims showing as rejected at the clearinghouse (not transmitted to payer) or claims with no acknowledgment after 15 business days require immediate review and resubmission if needed.
31-60 Days
Status: Claims outstanding beyond the standard adjudication window for most payers. Most clean claims should have been adjudicated by day 30-45. Claims in this bucket that haven’t received a response are starting to require active follow-up.
Follow-up action: Active payer inquiry payer portal status check, electronic status request (276/277 transaction), or phone call for payers without online status access. Document the follow-up contact, the status obtained, and the next action required.
Common findings at this stage: Claim in process (no action needed beyond re-check), additional documentation requested (respond promptly to avoid further delay), processing hold (identify reason and resolve), claim not received (resubmit with confirmation of original submission date to protect timely filing).
61-90 Days
Status: Claims significantly past normal adjudication timelines. A claim outstanding past 60 days without adjudication almost always has a specific reason a payer system issue, a processing hold, a documentation request that was missed, a COB issue pending resolution, or a claim that was lost or rejected at the payer level.
Follow-up action: Direct payer contact phone call with documented representative name and reference number, or portal escalation. Identify the specific reason for non-adjudication and take the required action to move the claim forward. If the claim requires resubmission, verify timely filing status before resubmitting.
Escalation criteria: Any claim in the 61–90 day bucket with no documented follow-up action is a priority it needs to be worked immediately, not at the next scheduled review cycle.
91–120 Days
Status: High-priority aging claims. At 90+ days, payer timely filing windows for many commercial payers are approaching. Medicare’s 12-month window is not yet at risk, but commercial payer windows as short as 90 days may be closing. Every claim in this bucket needs a status determination and a resolution path payment expected, appeal in process, resubmission required, or write-off decision.
Follow-up action: Escalated payer contact. If the claim is in denial, immediate appeal filing. If the claim requires resubmission, assess timely filing protection (original submission documentation, payer error exception, COB exception). If the claim is in dispute, document escalation steps and expected resolution timeline. Patient balance notification if payer adjudication will not be resolved favorably.
120+ Days
Status: Critically aged AR. Claims in this bucket are at significant risk of permanent write-off if not actively resolved. At 120+ days, timely filing windows for most commercial payers have closed or are very close. The recovery options narrow significantly.
Follow-up action: Final determination for every claim in this bucket payment received and unposted (posting reconciliation issue), appeal in final stage, irreversible timely filing denial (document and write off), patient balance conversion (bill patient for services payer will not cover), or bad debt determination. Every claim in the 120+ bucket needs a closed-loop outcome documented.
Write-off policy: We do not recommend blanket write-offs of aged AR. Every claim in the 120+ bucket is individually reviewed for recovery potential before write-off is recommended. A claim that appears uncollectable may have a recoverable path late COB discovery, payer error exception, or patient financial assistance eligibility that prevents unnecessary write-off.
Payer-Specific AR Follow-Up Workflows
Not all payers are followed up the same way. Each payer type has its own adjudication timelines, follow-up channels, and escalation processes. Treating all payers with the same follow-up workflow produces inefficient results spending time on payers with portal tools that resolve inquiries in minutes, and missing the escalation pathways available for payers with slower response patterns.
Medicare and Medicare Advantage
Medicare fee-for-service claims are generally adjudicated within 14–30 days for clean electronic claims. Status is available through the Medicare Administrative Contractor (MAC) portal. For claims beyond 30 days, MAC portal inquiry is the first step followed by written inquiry or phone contact with the MAC for unresolved holds.
Medicare Advantage plan follow-up varies by plan each MA plan has its own adjudication timeline, portal access, and escalation process. We maintain plan-specific follow-up workflows for each MA payer in your mix.
Commercial Payers (Aetna, BCBS, Cigna, UHC, Humana, etc.)
Major commercial payers offer online portal access for claim status. For most major payers, portal inquiry resolves status questions within one business day. When portal status indicates a processing issue, phone escalation with a documented reference number is the follow-up step. Commercial payer prompt payment laws in most states require adjudication within 30–45 days of clean claim receipt we reference applicable state prompt payment laws in escalation correspondence when timelines are exceeded.
Medicaid
Medicaid follow-up is state-specific. Adjudication timelines, portal access, and escalation processes vary by state. For practices billing multiple state Medicaid programs, we maintain state-specific follow-up references.
Workers’ Compensation
Workers’ compensation billing involves claim-specific adjuster contact rather than payer portal follow-up. WC claims require documentation of the authorized treatment plan, the date of injury, and the employer’s insurance carrier. Each claim has a specific adjuster who manages it follow-up is directly with the adjuster, with escalation to the carrier’s claim supervisor when adjuster response is delayed.
Auto Insurance (PIP/No-Fault)
Personal injury protection and no-fault insurance billing requires documentation of the accident date, claim number, and insured’s policy details. Follow-up is with the claim adjuster or the insurer’s medical payments department. Prompt follow-up on auto insurance claims is particularly important because policy limits can be exhausted a claim that arrives late may find coverage limits already met by prior claims.
Patient AR Follow-Up – Balances, Statements, and Collections
Insurance AR and patient AR require entirely different follow-up approaches. Insurance AR is a payer communication function. Patient AR is a patient communication and collections function one that must balance effective balance recovery with maintaining the patient relationship.
Patient Statement Cycle
Patient balances are generated after all applicable insurance adjudication is complete and the patient’s responsibility is confirmed. We generate clear, itemized patient statements that show what was billed, what insurance paid, what adjustments were applied, and what the patient owes with a plain-language explanation of each component.
Statement cycle timing:
- First statement: Sent within 5-7 business days of insurance adjudication confirming patient responsibility
- Second statement: Sent at 30 days if balance remains unpaid, with a friendly payment reminder
- Third statement: Sent at 60 days with a clear payment due date and payment options prominently displayed
- Final notice: Sent at 90 days indicating the balance will be referred for further action if not resolved
Payment Plan Management
For patients with balances that present a financial hardship, we manage payment plan arrangements structured monthly payment schedules that allow patients to resolve balances over time without the friction of a lump-sum demand. Payment plans improve collection rates on larger balances and preserve the patient relationship.
Patient Balance Communication Standards
Patient balance communications are handled with a professional, respectful tone that reflects well on your practice. Aggressive or confusing patient billing is one of the most common sources of patient complaints and negative reviews for medical practices. We maintain clear, patient-friendly communication standards on every balance notice.
Bad Debt and Write-Off Management
Patient balances that remain unresolved after the full statement cycle and follow-up process are evaluated for bad debt determination. We document the follow-up history, the balance amount, and the determination rationale before any patient balance write-off is recommended. For practices that refer patient balances to collection agencies, we provide the documentation package required for agency placement.
Key AR Performance Metrics We Track and Report (Accounts Receivable Follow Up Services)
AR performance is measurable and measurable performance is manageable. We track and report the following metrics monthly for every practice we work with.
Days in AR (DAR): The average number of days it takes from date of service to payment receipt. Industry benchmark for well-managed practices is typically 30–40 days. DAR above 50 indicates systemic AR management issues. We track DAR trend month-over-month improvement in DAR is one of the clearest indicators that a billing operation is getting better.
AR Aging Distribution: The percentage of total outstanding AR in each aging bucket (0–30, 31–60, 61–90, 91–120, 120+). A healthy AR aging distribution has the majority of outstanding AR in the 0–60 day range. A practice with more than 20–25% of AR in the 90+ bucket has a serious follow-up problem claims are aging without resolution.
First-Pass Acceptance Rate: The percentage of claims that are accepted and paid on the first submission without denial or resubmission. Higher first-pass rates mean less work in the AR queue and faster payment cycles.
Collection Rate: Net collections divided by net charges (after contractual adjustments). This is the most important revenue capture metric it measures what percentage of what the practice is entitled to collect actually comes in.
Denial Rate by Payer: Denial rates broken down by payer identify payer-specific billing issues a payer with a 20% denial rate compared to a 5% average across other payers is a signal of payer-specific coding, authorization, or documentation issues.
AR by Payer Mix: Outstanding AR broken down by payer shows where the largest receivable concentrations are useful for prioritizing follow-up effort and identifying payers with slower-than-average adjudication patterns.
Write-Off Rate: The percentage of total AR that is written off both contractual write-offs (expected) and bad debt write-offs (losses). Tracking write-off rates over time identifies whether the practice is writing off too aggressively (giving up on recoverable claims) or not aggressively enough (letting uncollectable AR artificially inflate the AR balance).
Our AR Follow-Up Process
Step 1 – Daily AR queue review. Every business day, the AR queue is reviewed for newly aging claims and action items from prior follow-up contacts. Claims that received payer responses are documented and either posted to payment posting, routed to denial management, or closed with documented outcomes.
Step 2 – 15-day follow-up initiation. Claims that have not received a response within 15 business days of submission are queued for initial status inquiry. Electronic status checks are performed through payer portals or 276/277 EDI transactions for payers that support electronic inquiry.
Step 3 – 30-day active follow-up. Claims outstanding at 30 days receive active follow-up — payer portal inquiry or phone contact with documented reference numbers. Status is recorded, and next action is determined based on payer response.
Step 4 – 60-day escalated follow-up. Claims outstanding at 60 days receive escalated follow-up — direct payer contact with documentation of prior follow-up history. Claims with identified holds or additional information requirements are resolved. Claims requiring resubmission are assessed for timely filing status.
Step 5 – 90-day priority resolution. Every claim outstanding at 90 days receives a priority review and a defined resolution path — payment expected with timeline, appeal in process, resubmission with timely filing protection, or write-off analysis. No claim reaches 90 days without a documented status and a next action.
Step 6 – 120+ day final determination. Claims in the 120+ bucket are individually reviewed for recovery potential. Every claim receives a final determination — closed with payment, closed with appeal outcome, written off with documented rationale, or converted to patient responsibility.
Step 7 – Monthly AR performance reporting. You receive monthly reports covering DAR trend, AR aging distribution, collection rate, denial rate by payer, follow-up activity summary, write-off analysis, and patient AR status. Full visibility into the state of your receivables and the actions being taken on every outstanding balance.
What Systematic AR Follow-Up Delivers
Faster payment cycles. Active follow-up accelerates adjudication on pending claims identifying and resolving holds, processing issues, and documentation requests that payers would otherwise let sit. Practices with structured AR follow-up consistently achieve lower days-in-AR than those without.
Higher collection rates. Claims that are followed up systematically are collected at significantly higher rates than claims that age without action. The difference between a 90% collection rate and a 95% collection rate is not a minor operational improvement at $400,000 in monthly billing, it is $20,000 per month.
Accurate financial picture. When AR is worked systematically and aging claims are closed with documented outcomes, the AR balance reflects what is actually collectible not a mix of genuinely outstanding claims and long-aged balances that should have been written off months ago. Accurate AR data enables better financial planning and practice management decisions.
Timely filing protection. Active 15/30/60-day follow-up cycles ensure that claims approaching timely filing windows are identified and actioned before the window closes. Timely filing denials are entirely preventable with a structured follow-up process.
Reduced administrative burden on your staff. AR follow-up is time-intensive, payer-specific, and requires current knowledge of each payer’s portal, phone processes, and escalation pathways. Outsourcing this function frees your staff for patient-facing work while ensuring AR is worked consistently not only when staff capacity allows.
Why Practices Choose Malakos Healthcare Solutions for AR Follow-Up
Structured 15/30/60-day cycle, without exception. Every claim gets followed up on schedule not when staff have time. The discipline of the follow-up cycle is what keeps AR from aging by default.
Payer-specific follow-up workflows. Medicare, Medicare Advantage, commercial payers, Medicaid, Workers’ Comp, and auto insurance each have distinct follow-up channels and escalation processes. We apply the right approach to each payer not a one-size-fits-all phone follow-up process.
Documented follow-up trail on every claim. Every follow-up contact is documented date, representative name, reference number, status obtained, and next action. When a claim reaches audit or dispute, the follow-up history is complete and immediately accessible.
Patient AR handled with care. Patient balance follow-up is managed with clear, respectful communications that maintain your practice’s patient relationships while recovering what is owed.
Monthly AR performance reporting. You see your DAR, aging distribution, collection rate, and denial trends every month. AR follow-up that’s working shows in these numbers and we’re accountable to them.
HIPAA-compliant operations. All data handling follows strict HIPAA protocols. A Business Associate Agreement (BAA) is included with every engagement.
Frequently Asked Questions – AR Follow-Up
What is days in AR and what should it be for a well-run practice? Days in AR (DAR) measures the average number of days from date of service to payment receipt. It is calculated as total AR divided by average daily charges. For a well-managed outpatient practice with clean claim submission and active AR follow-up, DAR should typically fall in the 30-40 day range. DAR between 40-50 indicates room for improvement. DAR above 50 consistently indicates systemic AR management problems likely a combination of high denial rates, slow follow-up, or significant 90+ day aging accumulation.
What is the difference between insurance AR and patient AR? Insurance AR represents outstanding balances owed by payers claims that have been submitted but not yet adjudicated, or claims in denial or appeal. Patient AR represents outstanding balances owed by patients co-pays, deductibles, co-insurance, and non-covered service charges after insurance has adjudicated. The two require completely different follow-up workflows: insurance AR requires payer communication through portals, phone, and EDI status requests; patient AR requires patient statements, payment plan management, and collections communication. Mixing the two in the same workflow produces poor results for both.
How do you handle claims that are approaching the timely filing deadline? Claims approaching timely filing windows are flagged in our AR queue and prioritized for immediate action. The priority action depends on the claim’s status: if the claim is pending adjudication, we escalate payer contact to obtain a status determination before the window closes; if the claim was denied and the filing window is approaching, we assess whether a timely filing exception applies (payer error, COB exception, administrative exception) and file accordingly; if a timely filing denial has already been received, we immediately assess whether an exception-based appeal is possible. Prevention is always the priority our 15/30/60-day follow-up cycle is designed specifically to ensure no claim reaches a timely filing deadline without prior follow-up.
What happens to patient balances that are not collected after the statement cycle? Patient balances that remain unresolved after our full statement cycle and follow-up process typically three to four statements over 90-120 days are evaluated individually. For some patients, we recommend extended payment plans or financial hardship review before final write-off. For balances that have exhausted all collection options, we provide a documented write-off recommendation with the complete follow-up history. For practices that use external collection agencies, we provide the documentation package required for agency placement. We do not recommend blanket write-offs or agency placement without individual balance review.
Can you take over AR follow-up for a practice that already has a significant backlog? Yes. AR backlog management is one of the most common situations we encounter when onboarding new practices. The first step in onboarding is an AR audit reviewing the outstanding balance by aging bucket, identifying which claims are still within appeal or timely filing windows, and prioritizing the backlog for systematic resolution. Claims within recovery windows are worked immediately; claims beyond recovery are documented and written off with rationale. We work through the backlog in parallel with managing new incoming claims no disruption to ongoing billing while the backlog is being resolved.
How quickly can we get started? Most practices are fully onboarded within 7-14 business days. For practices with AR backlogs, we begin the AR audit as part of onboarding and start working priority claims within the first week. You’ll have a dedicated account manager from day one one contact who knows your payer mix, your AR history, and your practice’s billing patterns.
Ready to Reduce Your Days in AR and Collect What You’re Owed?
If your practice has significant AR past 60 days, a collection rate below 90%, or an AR follow-up workflow that falls behind whenever your staff is busy we can fix it.
A free billing audit will show you exactly what’s sitting in your AR, what’s recoverable, and what a structured follow-up process would collect.
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