Recover unpaid claims and optimize your accounts receivable with expert A/R management that reduces outstanding balances and accelerates cash flow.
Visualize collection probability by aging bucket. Every day of delay reduces your likelihood of recovery.
Outstanding accounts receivable ties up cash flow and reduces practice profitability. These challenges prevent effective collections.
Outstanding balances continue to age beyond 90 days, reducing the likelihood of collection and negatively impacting cash flow and working capital.
Without structured follow-up processes, unpaid claims sit idle while timely filing limits expire and collection opportunities are permanently lost.
Contractual adjustments and payment variances are not systematically reviewed, allowing payers to underpay without detection or correction.
Manual, time-consuming A/R management processes drain staff resources while delivering poor results and inconsistent outcomes.
Ineffective payer communication and lack of dedicated follow-up staff result in extended resolution times for outstanding claims.
Without detailed reporting and analytics, practices cannot identify problems, prioritize efforts, or measure collection performance.
Our approach is built on transparency - you see exactly what we are doing, why, and what it produces.
Every component managed with precision and expertise.
Our expertise delivers measurable improvements in performance and revenue.
Our A/R management team recovers outstanding balances and reduces days in A/R by 40%. See how we can transform your collections.
Beyond immediate revenue recovery, our AR management delivers transformational long-term outcomes.
Consistent monthly collections replace unpredictable revenue cycles. Know exactly what is coming in, allowing confident business planning, staff expansion, and equipment investments without financial uncertainty.
Your staff stops spending hours on hold with insurance companies and chasing payments. They redirect that time to patient care, appointment scheduling, and practice growth initiatives that truly matter.
Clean A/R with minimal aging significantly increases your practice value. Whether planning for retirement, seeking investment, or positioning for acquisition, strong collections metrics make your practice more attractive.
Eliminate the anxiety of aging accounts receivable and mounting unpaid claims. Sleep better knowing experienced specialists are systematically working every dollar owed to your practice with proven results.
Strong cash flow allows you to invest in new technology, hire top talent, and expand services while competitors struggle with collections. Your financial stability becomes a strategic advantage.
Recovered revenue becomes working capital for expansion. Open new locations, add providers, launch new service lines, or upgrade equipment knowing your financial foundation is solid and optimized.
Studies show 2-5% of all payer payments contain variances; without systematic detection, these underpayments are accepted as final and represent permanent revenue loss.
Deep expertise your billing team can act on immediately to recover outstanding revenue.
Effective AR management begins with disciplined aging bucket analysis that prioritizes follow-up based on both dollar value and collection probability. The 0-30 day bucket requires monitoring, not active follow-up. Claims in the 31-60 day window should trigger initial payer status checks. The 61-90 day bucket is the critical inflection point where collection probability begins declining sharply and requires aggressive follow-up including phone calls and portal checks. Beyond 90 days, collection probability drops below 50%; beyond 120 days it falls below 25%. Strategic prioritization combines claim dollar value, payer payment history, denial reason recoverability, and timely filing deadlines. A weighted scoring system focusing on the 61-90 day bucket high-dollar claims maximizes recovery from limited follow-up capacity.
Denial management is the cornerstone of effective AR recovery. The most successful practices treat denials not as individual events but as data points in a pattern that reveals systemic revenue cycle weaknesses. Every denied claim should be categorized by CARC/RARC code, payer, CPT code, provider, and date range to build a comprehensive denial database. Analysis reveals actionable patterns: if a specific payer consistently denies 99214 visits for insufficient documentation, the root cause may be a documentation template issue, not a payer processing error. First-level appeals should be filed within 48 hours of denial receipt with targeted documentation. Second-level appeals should include peer-reviewed literature or specialist opinion letters. Tracking appeal outcomes by payer and denial reason reveals which denials are worth appealing and which should be corrected at the source.
Payment variance analysis is one of the most overlooked yet financially impactful components of AR management. Studies consistently show 2-5% of all payments contain variances that go undetected without systematic review. These include incorrect fee schedule application, improper bundling of separately billable services, incorrect modifier processing, and arbitrary downcoding without clinical justification. Detection requires maintaining a current fee schedule database for every contracted payer and automatically comparing each payment against expected reimbursement. ERA data should be parsed to flag payments below 95% of the expected contracted rate, routing flagged claims to a variance resolution team. Practices implementing systematic payment variance detection typically recover 2-4% of net revenue that would otherwise be permanently lost as accepted underpayments.
Effective AR management requires understanding which CPT codes drive the highest dollar volume in aging buckets, generate the most frequent denials, and carry the greatest financial impact when left unworked.
| Code | Description | Est. Range | AR Notes |
|---|---|---|---|
| 99213 | Office visit, established patient, low MDM - highest volume in AR aging | $75-$110 | Most frequently appearing code in AR aging buckets due to sheer volume. Small underpayments per claim compound into significant revenue loss. Monitor contracted rates closely. |
| 99214 | Office visit, established patient, moderate MDM - frequent denial target | $110-$165 | Second most common code in AR. Frequently denied for insufficient documentation or downcoded to 99213. Track denial patterns by payer monthly to identify systemic issues. |
| 99215 | Office visit, established patient, high MDM - highest single-claim E/M value | $150-$225 | High-value E/M code with elevated denial risk. Medicare and MA plans audit this code aggressively. Ensure documentation supports high-complexity MDM before pursuing appeals. |
| Code | Description | Est. Range | AR Notes |
|---|---|---|---|
| 99283 | Emergency department visit, moderate complexity | $120-$200 | Commonly underpaid by commercial payers. No Surprises Act protections apply for out-of-network emergency claims. Track IDR outcomes for payer-specific payment trends. |
| Code | Description | Est. Range | AR Notes |
|---|---|---|---|
| 92928 | Percutaneous coronary stent placement, single vessel | $1,800-$3,500 | High-dollar code frequently denied for prior authorization failures or bundling issues. A single unpaid claim at this level justifies dedicated follow-up resources. |
| 27447 | Total knee arthroplasty | $1,500-$3,000 | Common high-dollar surgical code. Denials often relate to medical necessity documentation or prior authorization. Appeals require operative report and clinical justification. |
| 43239 | Upper GI endoscopy with biopsy | $250-$500 | Frequently denied when billed with E/M on same day without modifier 25. Bundling edits with pathology codes are a common denial pattern requiring modifier resolution. |
| Code | Description | Est. Range | AR Notes |
|---|---|---|---|
| 70553 | MRI brain without contrast then with contrast and further sequences | $350-$700 | Prior authorization required by most commercial payers. Common timely filing risk when authorization delays push claim submission past payer deadlines. |
| 73721 | MRI any joint of lower extremity without contrast | $250-$500 | High-volume imaging code frequently denied for missing prior authorization or insufficient clinical indication. Track authorization-to-claim conversion rates. |
| Code | Description | Est. Range | AR Notes |
|---|---|---|---|
| 90834 | Psychotherapy, 45 minutes | $80-$130 | Behavioral health codes have high denial rates due to session documentation requirements and authorization limits. Track remaining authorized sessions to prevent denials. |
| 17000 | Destruction of premalignant lesion, first lesion | $60-$120 | Commonly denied when billed with E/M without modifier 25 or when documentation does not support separate lesion destruction. High volume makes AR impact significant. |
| 99232 | Subsequent hospital care, moderate complexity | $75-$120 | High-volume inpatient code. Frequently denied for concurrent care without modifier indicating distinct service. Hospital rounding charges age quickly without systematic follow-up. |
CPT codes and reimbursement ranges are for educational reference only. Actual reimbursement varies by payer, region, and contract.
AR management strategies must be tailored to each payer timely filing deadlines, appeal processes, payment behaviors, and denial patterns. Understanding payer nuances is the difference between systematic revenue recovery and permanent write-offs.
Let our experts show you how we can recover outstanding balances, reduce A/R days by 40%, and transform your collections performance. Schedule a free consultation today.