A/R Recovery for Medical Billing: Old Claims Worked, Paid Claims Followed Up
A/R recovery is the work of getting paid on claims that are sitting unpaid, underpaid or stuck with a payer. We clean up your old accounts receivable, then keep every open claim moving so the backlog does not return.
Written by Salman Saeed, CEO and Co-Founder · Reviewed by a Certified Medical Coder · Last reviewed October 2026- 97%client retention
- 95%clean claim rate
- Since 2018billing for US practices
- 48 hrsto work each denial
Included with Our Billing
What every billing client gets.
- EHR or PM softwareFree for every billing client.
- No setup feeNo fee to set up your billing.
- Old A/R workedAt no extra fee.
- A dedicated account managerIncluded for every billing client.
- Patient billingPatient statements and patient billing calls, at no extra fee.
- Monthly performance reportsIncluded with your billing.
In short: A/R recovery means finding every unpaid claim, working it in order of age and dollar value, and acting before a filing or appeal deadline closes the door. We do the cleanup once, then run the follow-up every week. Our clients see 15 to 20% revenue recovered from denials and old A/R.
What Is A/R Recovery in Medical Billing?
A/R recovery is a focused effort to collect money owed on claims that have already been billed but not paid. Accounts receivable (A/R) is the total of those open balances, from payers and from patients.
It covers three kinds of claims. Some were never answered by the payer. Some were paid below the contract rate. Some were denied and nobody worked the denial. Each kind needs a different action, and each has a clock.
At a hospital or large group the amounts add up fast. A single payer holding a few hundred claims past 90 days can represent more cash than a month of new charges. That is why we treat old A/R as its own project and not a side task for the front-line billers.
Our figure is 15 to 20% revenue recovered from denials and old A/R. It describes recovered revenue, not a promise for any one account, because the mix of payers, claim ages and documentation is different at every client.
How Do You Work Claims Older Than 90 or 120 Days?
We sort every open claim into an aging bucket, then work from the oldest and largest first. An aging bucket is a band of days since the date of service or the claim submission date, such as 0 to 30, 31 to 60, 61 to 90, 91 to 120 and over 120 days.
Claims past 90 and 120 days get a human look, not an automated resubmission. Most of them are old for a reason: a missing authorization, a coordination of benefits problem, a payer that lost the claim, or a denial that was posted and forgotten. We find the reason first, then pick the fix.
| Bucket | What it usually means | What we do |
|---|---|---|
| 0 to 30 days | Normal payer turnaround | Confirm the payer received the claim; no chasing yet |
| 31 to 60 days | Claim may be pending, lost or rejected | Check status in the payer portal; resubmit if the payer has no record |
| 61 to 90 days | Likely an issue with the claim or a missing document | Call the payer, find the hold reason, send what is missing |
| 91 to 120 days | Probable denial, underpayment or stalled review | Work the denial or file a reconsideration with records attached |
| Over 120 days | Deadline risk; the claim may be near a filing or appeal limit | Check the filing and appeal windows first, then act or write off with approval |
We read the remittance advice (the electronic file, called an ERA, that tells you how the payer paid or denied) for every aged claim. The CARC and RARC codes on it tell us whether to rebill, appeal or correct.
How Do You Prioritize Which Old Claims to Chase?
We rank by deadline first, dollars second, effort third. A smaller claim with a filing limit closing next week goes ahead of a larger claim with eight months of room.
- Claims about to cross a timely filing or appeal limit, with the payer's own limit confirmed from the contract or provider manual.
- High-balance claims that are older than 90 days, grouped by payer so one call or one portal session covers many accounts.
- Denials with a clear fix (missing information, wrong modifier, a missing authorization that can be obtained after the fact).
- Underpayments against the contract rate, worked as a batch per payer.
- Small balances, handled together at the end, or sent to patient billing when the balance is the patient's.
Is There a Timely Filing Limit for Old Claims I Can Still Rebill?
Yes. Every payer has a timely filing limit, which is the last day a claim can be received for payment. Under 42 CFR 424.44, a Medicare claim must be filed no later than the close of the period ending 1 calendar year after the date of service.
Commercial and Medicaid limits come from the contract or the state, so they differ by payer. We read the limit from your contract or the payer's own provider manual, and we do not guess it. Our timely filing limits by payer page lists what we have confirmed, and the timely filing calculator works out a last day for one claim.
Medicare allows exceptions. Under 42 CFR 424.44(b), the time is extended when CMS or a contractor determines the delay was caused by an error or misrepresentation by a Medicare employee or contractor. It is also extended in some cases of retroactive Medicare entitlement. We build the exception request when the facts fit, with the proof attached.
What Appeal Windows Apply to Old Denials?
For Medicare fee-for-service, the first appeal has to be requested within 120 calendar days of receiving the initial determination. Under 42 CFR 405.942, the date of receipt is presumed to be 5 calendar days after the date on the notice, unless there is evidence otherwise.
The second level is shorter in text but longer in time. Under 42 CFR 405.962, a request for reconsideration by a qualified independent contractor (QIC) must be filed within 180 calendar days from the date the party receives the redetermination notice. A MAC, the Medicare Administrative Contractor, handles the first level. See the full path on our Medicare appeal levels page.
| Step | Deadline | Rule |
|---|---|---|
| Redetermination (first appeal) | 120 calendar days from receipt of the initial determination | 42 CFR 405.942(a) |
| Receipt presumed | 5 calendar days after the notice date | 42 CFR 405.942(a)(1) |
| Reconsideration by a QIC (second appeal) | 180 calendar days from receipt of the redetermination | 42 CFR 405.962(a) |
| Late requests | Possible only with a written showing of good cause | 42 CFR 405.942(b), 405.962(b) |
Reopening is the route for a claim whose appeal window has passed. Under 42 CFR 405.980(c), a party can ask a Medicare contractor to reopen an initial determination within 1 year of the determination for any reason, or within 4 years for good cause. A clerical error, such as a denial as a duplicate, is processed as a reopening instead of a redetermination.
Commercial payers set their own appeal limits, usually written in the denial letter and the provider manual. We take the date from that letter. Where appeals become the main work, our denial management service owns them end to end.
Talk to a Billing Lead.
A 20-minute call about your payers, volume and setup. Monday to Friday, 9am to 5pm Eastern.
How Does Payer Follow-Up Work?
Payer follow-up is a repeated, documented contact with the payer about a specific claim until it is paid, denied with a reason, or written off. One call with no note is not follow-up.
How Is A/R Recovery Different from Denial Management?
Denial management works claims the payer has already answered with a denial, and prevents repeats. A/R recovery works everything that is still unpaid, whether or not it was denied, and focuses on age.
They overlap on aged denials, so we run them together. Denials are worked within 48 hours of reaching us. Old A/R covers the rest of the backlog: claims with no response, short payments and balances nobody owns. See denial management for the denial side.
What Do You Need from Us to Start?
Access is set up under a Business Associate Agreement, with two-step login on every system. If there is no clean aging report, we build one from the claim data.
How Do You Report on A/R Progress?
You get a report that shows the same few numbers each time, by payer and by aging bucket, so you can see change instead of reading a narrative. The reporting schedule is agreed at kickoff.
- A/R by aging bucket and by payer, compared with the previous report
- Dollars collected from claims that were over 90 days old
- Claims appealed, claims at risk of a deadline, and the next action on each
- Balances recommended for write-off, with the reason
- Root causes found, such as the same missing authorization or the same payer delay
The root-cause list is the part that keeps A/R from building up again. When old claims point to a front-end or coding problem, we say where. Our revenue cycle management service covers fixing it upstream, and medical billing covers the daily claim work.
How We Handle A/R Recovery at Nucleus Align
We start with your aging report, rank every open claim by deadline and dollars, and begin with the claims closest to a limit. Our team works from your EHR, clearinghouse and payer portals, with controls on how each account is touched and logged.
For hospital clients, that includes institutional UB-04 claims as well as professional claims, because the same payer often holds both. Denials reach our team and are worked within 48 hours, and claims we bill are sent within 24 hours of charge entry, so new A/R stays young while we clear the old.
For our billing clients, working your old A/R is part of the service at no extra fee.
Pricing for billing services is on the pricing page, and we do not quote it here. To talk through your aging report, book a call and send the report ahead if you have it.
- 42 CFR 424.44, Time limits for filing claims · eCFR
- 42 CFR 405.942, Time frame for filing a request for a redetermination · eCFR
- 42 CFR 405.962, Timeframe for filing a request for a reconsideration · eCFR
- 42 CFR 405.980, Reopening of initial determinations, redeterminations, reconsiderations, decisions, and reviews · eCFR
We check every rule, code and deadline against the official source. See our editorial policy.
Who We Do This For
Common Questions
Straight answers from the team that does the work.
Ask a billing lead directly. A 20-minute call, Monday to Friday, 9am to 5pm Eastern.
01What is A/R recovery in medical billing?
A/R recovery is the work of collecting on claims that were billed but never fully paid. It covers claims with no payer response, short payments and unworked denials. We rank them by age and dollar value, then rebill, appeal or follow up with the payer before a deadline closes.
02How do you work claims older than 90 or 120 days?
We read the remittance codes and payer notes on each one to find why it is still open. Then we pick the fix: a corrected claim, a records request, a reconsideration or a call to the payer. Over 120 days, we check the filing and appeal limits before anything else.
03What is a good days in A/R number?
No single number fits every hospital, because payer mix and specialty change it. Compare your own trend by payer, month over month, and watch the share of A/R over 90 days. Our calculator on this site computes days in A/R the same way each time.
04How do you prioritize which old claims to chase?
Deadline first, then dollars, then effort. A claim closing in on a payer's timely filing or appeal limit goes first. Next come high-balance claims over 90 days, grouped by payer, then clean denials with an obvious fix, then small balances worked as a batch.
05Is there a timely filing limit for old claims I can still rebill?
Yes. Medicare claims must be filed within 1 calendar year of the date of service under 42 CFR 424.44, with listed exceptions. Commercial and Medicaid limits come from the contract or the state. We confirm each payer's limit in writing before we rebill an old claim.
06How much of aged A/R is typically recoverable?
It depends on age, payer and reason, so we do not quote a rate before seeing your aging report. Our figure is 15 to 20% revenue recovered from denials and old A/R. Claims inside their filing windows are far more collectible than those past them.
07Do you charge a percent of what you recover or a flat fee?
Pricing is on our pricing page and not repeated here, so the figures stay in one place. When you book a call we explain what applies to your account and what the pricing covers, with the details in writing before any work starts.
08How is A/R recovery different from denial management?
Denial management starts with a payer denial and focuses on overturning it and preventing repeats. A/R recovery starts with any unpaid balance, ranked by age, and includes claims nobody has answered. We run both together, since aged denials sit in both.
09What do you need from us to start?
An aging report by payer and claim, recent remittance advice, read access to payer portals and clearinghouse reports, the payer contracts or limits that apply, and one contact for record requests. If there is no clean aging report, we build one from your claim data.
10How do you handle A/R left behind by a former biller?
We inventory every open claim, rebuild the history from remittances and payer portals, and work it by age. Inherited accounts often have no notes, so the first week goes to finding what each payer has on file. Claims past all deadlines get a write-off recommendation.
11Can you recover A/R from a closed practice or acquired facility?
Usually, if the claims are inside payer limits and the records can be accessed. For an acquired facility we confirm the tax ID and NPI the claims were billed under. For a closed practice we check record retention, authorization and the payer deadlines first.
12When should unpaid balances go to patient collections instead?
Only when the payer has finished processing and the remaining balance is the patient's deductible, copay or coinsurance. Anything the insurer still owes stays in A/R recovery. We confirm final payer payment first, then pass the balance to patient billing.
Talk to a Billing Lead.
A 20-minute call about your payers, volume and setup. Monday to Friday, 9am to 5pm Eastern.