How much of my AR should be over 90 days, and how do I fix it if too much is?
There is no single sourced benchmark we can quote for the right share, so track your own trend rather than a borrowed number. Our own published guidance is that a practice calling its aged accounts keeps days in AR under forty; past sixty usually means nobody is working the old end of the bucket at all.
The detail
We have not found a government or association figure stating what share of AR should sit past ninety days, and a page quoting one without a source is guessing; rather than invent a number, this page says so plainly.
What is measurable is your own trend: if the share of AR past ninety days is growing month over month, that bucket is not being worked, regardless of what any average states. Our own glossary entry on days in AR puts a working practice under forty days and flags sixty or more as a sign nobody is calling on the aged end; see /glossary/.
AR-follow-up-only outsourcing exists specifically for this problem, so the aged bucket gets a dedicated caller rather than competing with new claims for attention. See /services/ar-calling-denial-management/.
How do I recover unpaid insurance claims that are sitting in AR?
Call the payer on every claim past the normal payment window, in age order starting with the oldest, and document the reference number for every call. Most unpaid claims are not actually denied; they are simply sitting in a queue nobody has followed up on, and a phone call resolves a large share of them.
The detail
The first step on any unpaid claim is finding out why it has not paid: still in process, denied without a notice reaching you, or rejected before it ever reached adjudication. Each needs a different action, and guessing wastes the call.
Work oldest first, because timely-filing and appeal deadlines are fixed and the oldest claims are closest to losing their appeal rights entirely. Document the payer representative's name, the call reference number and the stated resolution on every call; that record is what makes a second call, or an escalation, effective instead of starting over.
If the backlog is too large to work through with current staff, a dedicated AR-follow-up seat exists specifically to work the aged queue; see /services/ar-calling-denial-management/.
How can I reduce my medical claim denial rate?
Fix eligibility and authorization before the claim is submitted, since most denials trace back to something that was wrong before the claim ever left the building. Track denials by reason code rather than treating them as one problem, because eligibility, authorization and coding denials each need a different fix.
The detail
Denial rates are rising industry-wide, not only at under-resourced practices: the initial denial rate across more than two thousand hospitals rose to nearly twelve percent of claims in 2024, up from the year before. Most of that is preventable upstream rather than fixable after the fact.
Group your own denials by reason code for one month and the pattern usually points at a single upstream fix: eligibility not verified before the visit, an authorization not obtained, or a coding or documentation gap. Fixing the biggest single category moves the rate more than a general effort to 'try harder' on all of them.
A dedicated denial-management seat exists to do exactly this tracking and follow-up continuously rather than as a monthly fire drill; see /services/ar-calling-denial-management/.
What are the most common reasons medical claims get denied?
Eligibility and coverage issues, missing or absent prior authorization, and coding or documentation errors account for most denials industry-wide. Individual denial codes vary by payer, but these three categories, checkable before a claim is ever submitted, explain the majority of what gets rejected.
The detail
Industry data on denial causes consistently groups the biggest categories the same way: coverage not active or not verified at the time of service, a required prior authorization that was missing or did not match the service billed, and coding or documentation that did not support the claim as submitted.
The initial denial rate across the industry rose to nearly twelve percent of claims in 2024, and insurers ultimately pay roughly ninety percent of all claims eventually, which means a large share of denials are a delay to be worked rather than a final no. Every specific denial code's own meaning is answered on /denials/<code>/ and grouped by cause on /answers/denials-eligibility/, /answers/denials-coding/ and /answers/denials-authorization/.
Should I appeal a denial or file a corrected claim?
File a corrected claim when the original had an error you can fix, such as a wrong code or missing field; appeal when the claim was accurate and you are disputing the payer's decision, such as a missing-authorization denial you believe should be covered. CO-197, missing prior authorization, is the clearest worked example of the difference.
The detail
A corrected claim replaces a claim that was wrong on submission: the diagnosis code, the modifier, a date, or a field the payer's edit caught. It resubmits through the normal claims process rather than a dispute process, and timely-filing deadlines still apply exactly as they did to the original.
An appeal disputes a decision made on a claim that was, as far as you know, correct when submitted. It follows the payer's or Medicare's formal appeal process, has its own deadline separate from timely filing, and requires the specific documentation the denial reason calls for.
CO-197, denied for missing prior authorization, is worked through in full, including when each path applies, on /denials/co-197/.
When do I write off an unpaid balance versus send it to collections?
Write off a balance only when it is a true contractual adjustment your payer contract requires, shown as a CO group code on the remittance; a PR-coded balance is the patient's responsibility and can legitimately be pursued or sent to collections. Mixing the two quietly loses money that was actually billable.
The detail
The remittance's group code decides the answer before any policy judgment is needed: CO means a contractual obligation you agreed to under your payer contract and may not bill to the patient; PR means patient responsibility and is billable. Writing off a PR balance as if it were CO is simply giving away collectible money.
Beyond that distinction, the decision to pursue, write off, or escalate a patient balance to collections is a business policy choice, not one this page can make for you; what it can say is that the group code on the remittance should always be checked first, because automating a CO-versus-PR decision incorrectly is a common quiet loss in a billing workflow.
Is AR-follow-up-only outsourcing something I can actually buy, without full billing?
Yes. AR follow-up, calling payers on aged claims and working denials to resolution, is sold as its own dedicated seat, separate from charge entry, coding or payment posting. A practice keeps the rest of its billing workflow exactly as it is and adds one person for the aged queue specifically.
The detail
This is one of the narrowest and lowest-risk ways to test outsourcing: nothing changes about how claims are submitted or coded, and the only new thing is a dedicated person calling payers and working denials on the accounts that are already aged.
It is also often the highest-leverage single hire, because aged AR is where revenue quietly stops moving while the rest of the practice looks normal on paper. See /services/ar-calling-denial-management/ for the seat's published price and scope.
What does it actually cost to fight a denied claim?
A national provider survey put the administrative cost of fighting a single denied claim at roughly fifty-seven dollars in 2023, up from under forty-four dollars the year before, and found a denied claim typically goes through about three rounds of payer review at forty-five to sixty days each round.
The detail
Premier Inc.'s national provider survey found the administrative cost of fighting a single denied claim rose from under forty-four dollars in 2022 to roughly fifty-seven dollars in 2023, and that a denied claim went through an average of three review cycles with insurers, each cycle taking forty-five to sixty days.
At scale, the American Hospital Association reported hospitals spent close to eighteen billion dollars in a single year overturning claim denials alone. Those figures explain why preventing a denial upstream, through eligibility and authorization checks, is consistently cheaper than winning the appeal after the fact.
