Scope for each practice is confirmed in the engagement agreement, including systems, payers, and queues.
Aging reports describe the past. They do not assign the next call
A practice prints A/R by bucket and asks staff to start at the top. Payers that require a status call, claims that were never accepted, and balances that are already patient responsibility get the same treatment. Days in A/R rise because the queue has no rule. Follow-up support adds the rule and writes down what the payer said.
What the work includes
- A work queue of open claims past an agreed age
- Status checks using portal, phone, or 276/277 claim-status transactions where they return something usable
- Notes that record the reference number and the next date
- Hand-off to denial, posting, or patient billing when the status changes
- Timely filing watches for claims that are still unaccepted
- A weekly view of untouched inventory
How the work moves
Step 1
Build the queue from status, not only age
Unbilled, rejected, in process, denied, and patient-balance items are not one list. Age is the second sort.
Step 2
Touch with a purpose
Each touch has a question: was it received, was it requested for records, was it paid and unposted. The note has to answer that question.
Step 3
Move the claim out of limbo
A status that means denied is recategorized the same day. A status that means paid is sent to posting with the check or EFT reference.
Step 4
Retire stale work
Balances the practice's policy says to write off are presented for approval. They are not left open to flatter a follow-up count.
Operational benefits
- Filing deadlines surface while they can still be met
- Notes a second person can act on
- Less time spent rechecking claims that already paid
- Days in A/R discussed alongside untouched inventory
Common challenges
- Payer phone trees consume time without changing status
- 276/277 responses are often thinner than a portal
- A large credit balance can distort days in A/R
- Follow-up cannot create documentation that was never written
Technology
The queue should live where the balance lives, which is usually the practice management system. Side spreadsheets are a bridge during cleanup, not the permanent system. Claim-status transactions are used when they add information the portal would otherwise require a call to get.
Where specialty changes the work
High-dollar surgical claims justify a call. High-count primary care claims justify a better edit. Follow-up staffing follows that mix, which is why the assessment asks for specialty and volume separately.
Questions
How many times will you call a payer?
As many as the status justifies, inside the deadline, with notes. Repeat calls that do not change the next step are a process problem, not a badge of effort.
Do you include patient balances in A/R follow-up?
Payer follow-up and patient collections are related and separately staffed. A balance moves to the patient path when the remit says it is the patient's, and not before.
Can you lower our days in A/R to a target you publish?
No. Days in A/R moves when unbilled work, denials, and unposted cash move. We baseline the measure and show the drivers. We do not advertise a day count.