How to Manage Accounts Receivable in Your Healthcare Practice
Category: Revenue Cycle Management
Accounts receivable (A/R) represents payments that a healthcare practice is still owed. These balances may include unpaid insurance claims, underpayments, claims awaiting corrections, and patient balances.
When A/R is not monitored consistently, practices may struggle to identify delayed payments, resolve claim issues, and understand their actual financial position. A structured follow-up process can improve visibility and help teams prioritize their work.
1. Review Your A/R Aging Report Regularly
An A/R aging report groups outstanding balances by how long they have remained unpaid. Many practices review balances in categories such as 0–30, 31–60, 61–90, and over 90 days.
These categories are useful for organizing follow-up, but they should not replace payer-specific timely filing, reconsideration, or appeal deadlines.
Recommended actions:
Review aging reports at a consistent interval.
Identify older balances requiring immediate attention.
Separate insurance balances from patient responsibility.
Prioritize claims based on deadlines, balance amounts, and the next available resolution step.
Track changes in outstanding balances over time.
The goal is not simply to reduce the A/R total. It is to understand why balances remain outstanding and take appropriate action.
2. Investigate Unpaid Claims
An unpaid claim may be pending, rejected, denied, incorrectly processed, or missing information. Each situation requires a different response.
For every unresolved claim, determine:
Whether the claim was successfully received.
Whether it was accepted for adjudication.
Whether the payer needs additional documentation.
Whether an authorization or eligibility issue exists.
Whether a denial, rejection, or other processing issue must be corrected.
Whether a follow-up, reconsideration, or appeal is appropriate.
Record the action taken, the payer representative or portal information when available, any reference number, and the next follow-up date.
This documentation reduces duplicated work and makes unresolved cases easier to manage.
3. Manage Denials and Underpayments
Denials and underpayments can contribute to outstanding A/R when they are not investigated promptly.
Create a denial tracking log with the patient or claim identifier, payer, date of service, billed amount, reason for denial, responsible party, next action, and status.
Then look for recurring patterns. For example, repeated authorization denials may indicate a need to improve authorization tracking, while frequent provider-information errors may point to inconsistent enrollment records.
For underpayments, compare the payer's remittance information with the applicable contract, fee schedule, benefit rules, and claim details before determining whether additional action is warranted.
Not every denial is appealable, and not every payment difference is an underpayment. Review the circumstances and payer guidance before proceeding.
4. Reconcile Payments and Adjustments
Accurate payment posting is essential for understanding outstanding balances.
A strong reconciliation process includes:
Matching payments to the correct claims.
Reviewing ERA and EOB details.
Recording adjustments and contractual write-offs appropriately.
Investigating partial payments and unexplained differences.
Comparing posted payments with deposit and financial records.
Escalating discrepancies that cannot be resolved through routine review.
Unposted payments can make A/R appear higher than it actually is, while incorrect adjustments can hide balances that still require follow-up.
5. Establish a Consistent Follow-Up Workflow
Assign clear responsibility for reviewing claims, correcting errors, contacting payers, and monitoring outstanding issues.
A simple workflow might include:
Step 1: Generate and review the A/R aging report.
Step 2: Identify high-priority claims and upcoming deadlines.
Step 3: Investigate the reason each claim remains unpaid.
Step 4: Complete the appropriate correction, inquiry, reconsideration, or appeal.
Step 5: Document the outcome and schedule the next follow-up.
Step 6: Review unresolved balances and recurring issues with the team.
Consistent follow-up helps prevent claims from being overlooked and creates a clearer record of the practice's revenue cycle activity.
6. Measure Performance With Meaningful Metrics
Practices can use several metrics to evaluate their A/R processes:
Total outstanding A/R: The amount still owed to the practice.
A/R aging distribution: How much of the outstanding balance falls into each aging category.
Denial rate: The proportion of claims denied under a clearly defined measurement method.
Days in A/R: An estimate of how long receivables remain outstanding, calculated using a consistent methodology.
Collection rate: A measure of payments collected relative to a clearly defined expected or collectible amount.
Definitions, reporting periods, and calculation methods matter. Use consistent data when comparing results over time, and interpret each metric alongside the practice's payer mix and billing circumstances.
Strengthen Your Revenue Cycle
Effective A/R management requires more than making follow-up calls. It combines accurate claim submission, timely payment posting, denial analysis, reconciliation, and consistent reporting.
By reviewing outstanding balances regularly and assigning clear next steps, healthcare practices can gain better visibility into unresolved claims and make more informed financial decisions.
Let Nexora help you manage the details.
Nexora Revenue Services LLC supports ABA, behavioral health, and medical practices with billing, payment posting, denial follow-up, and accounts receivable monitoring.
Phone: 786-634-7425
Email: admin@nexorarevenueservicesllc.com
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Disclaimer: This article provides general educational information. Billing practices, payer deadlines, contractual obligations, and reimbursement policies vary. Always consult the applicable payer requirements and agreements.