A/R Follow-Up Services: How to Recover Claims Over 90 Days

A/R follow-up services recover money that payers owe but haven't paid. The work is unglamorous: sort unpaid claims by age, payer and dollar amount, find out why each one is stuck, fix it and resubmit or appeal before the deadline closes. Claims over 90 days old are still collectible in many cases, but every week they sit, the odds drop and the deadlines get closer.

Why aged A/R keeps growing

Most practices don't ignore aged claims on purpose. They run out of time. The same people who post payments and submit new claims are supposed to call payers about old ones, and the new work always wins.

Payer behavior adds pressure. In a July 2026 MGMA Stat poll, 32% of medical group leaders said their days in A/R were higher than a year earlier, 43% said about the same and 22% said lower. Respondents pointed to payer delays, increased initial denials, prepayment audits and slow appeal outcomes. The same MGMA analysis notes that in an earlier 2026 poll, 48% of leaders named denials and appeals as their largest source of revenue leakage.

The deadlines that matter

Aged A/R is a race against payer deadlines. Know them for every major payer.

Build a payer deadline sheet and keep it current. Pull the timely filing and appeal limits from each payer contract and provider manual. When a claim is within 30 days of a limit, it moves to the top of the queue.

A five-step process for A/R over 90 days

1. Pull an aging report by payer

Run an aging report with buckets for 0–30, 31–60, 61–90, 91–120 and over 120 days, split by payer. Export the claim-level detail: patient, date of service, CPT codes, billed amount, balance, last action and last action date.

2. Triage before you call

Don't work the list top to bottom. Sort it:

1. Deadline risk first. Claims nearing a filing or appeal limit.
2. Dollar value second. High-balance claims before small ones.
3. Group by payer. One call to a payer can cover several claims.
4. Separate patient balances. Patient responsibility goes to a different workflow.

Write off nothing yet. Flag claims that look uncollectible for review by the billing lead.

3. Find the root cause of each claim

Every stuck claim falls into a category. Track it, because the categories tell you what to fix upstream.

• No claim on file. The payer never received it. Check clearinghouse reports and resubmit with proof of timely filing.
• Rejected for data errors. Wrong member ID, subscriber, date of birth or NPI. Correct and resubmit.
• Denied for eligibility. Coverage terminated or another payer is primary. Verify coverage and rebill the right payer.
• Denied for authorization. No prior authorization or the wrong one. Check whether a retro authorization is possible, then appeal.
• Denied for coding or medical necessity. Review documentation with the coder or provider, correct or appeal with records.
• Pending or in process. The payer is sitting on it. Get a reference number, a date and escalate if it slips.
• Underpaid. Paid below the contracted rate. Compare with the fee schedule and dispute.

4. Act, document and set a next date

Every touch ends with an action and a follow-up date in the billing system: corrected and resubmitted, appealed, escalated, sent to the patient or flagged for write-off review. Notes need the payer rep's name, call reference number and what was promised. Without notes, the next person starts over.

5. Report what was recovered

Track monthly:

• Total A/R and A/R over 90 and over 120 days, by payer
• Dollars collected from claims over 90 days
• Denial categories and counts
• Claims written off, with reason
• Average days to resolution

Fix the front end, or the backlog comes back

A/R follow-up recovers money already at risk. It doesn't stop new claims from getting stuck. If your root-cause tracking shows the same categories every month, fix them where they start:

• Eligibility errors point to front-desk verification before the visit.
• Authorization denials point to the prior authorization process. Our article on prior authorization outsourcing in 2026 covers what the new CMS rules change.
• Coding denials point to documentation and coder review.
• Repeated payer delays should be tracked by payer and brought to contract discussions.

When to outsource A/R follow-up

Outsourcing A/R follow-up makes sense when:

• Claims over 90 days keep growing month after month.
• Nobody on staff has protected time to call payers.
• Appeals are filed late or not at all.
• You're changing billing systems or billing vendors and old A/R is being left behind.

It makes less sense when your team already works aged A/R weekly and the balance is shrinking, or when most of your aged balance is patient responsibility rather than payer A/R.

If you do outsource, define the scope clearly: which payers, which age buckets, what authority the team has to correct and resubmit, who approves write-offs and how results are reported. The vendor will need access to your practice management system and clearinghouse, so put a Business Associate Agreement and access controls in place before work starts.

Key takeaways

• Sort aged A/R by deadline risk, dollar value and payer before working it.
• Medicare generally requires claims within 12 months of service and redetermination requests within 120 days of the initial determination.
• Track the root cause of every stuck claim and fix the top categories upstream.
• Every touch needs an action, notes and a next follow-up date.
• Outsource when aged A/R keeps growing because nobody has time to work it.

Telemed provides A/R follow-up and denial management support for U.S. practices, working in your billing system with monthly reporting.