With approximately ten weeks left in 2026, now is the ideal time to thoroughly review the outstanding accounts receivable in your billing system. Every practice or care center accumulates unpaid balances; however, it is the claims that are more than 90 days old that quietly erode your revenue. As the weeks go by, collecting these amounts becomes increasingly difficult there is a risk of exceeding the filing deadlines set by payers, and such cases are often forgotten amidst the hustle and bustle of the holiday season. A focused effort, from now until December, can turn a report of stagnant accounts into actual revenue. This guide presents a step-by-step plan for recovering accounts receivable that any care center can implement.

Why Aging A/R Deserves Attention Right Now

Unpaid claims lose value over time, and the reasons for this are practical, not mysterious. The deadlines established by payers for the submission and appeal of claims continue to run, and case files become increasingly difficult to recover. Patients may forget about their visit, and staff members who were familiar with the details of a case may have moved on to other roles. According to general industry standards, collecting on claims that are more than 90 days old is significantly more challenging than collecting on those less than 60 days old; for this reason, most healthcare facilities monitor the percentage of accounts receivable that exceed 90 days as a key indicator of their financial health.

The end of the year adds further pressure. On January 1st, insurance deductibles reset, payer policies and billing codes change, and funds in Flexible Spending Accounts (FSAs) may expire if the patient’s plan does not allow them to be carried over to the next period. Bringing your accounts receivable up to date now will allow you to begin 2027 with a lighter workload and a clearer view of your cash flow.

Step 1: Build an Accurate Aging Report

You cannot fix what you cannot see. Start by generating an accounts receivable (A/R) aging report that categorizes balances into the following standard intervals: 0–30 days, 31–60, 61–90, 91–120, and over 120 days. Then, break down each category in two ways:

1. By payer, to identify whether a specific insurer is responsible for a disproportionate share of the delays.
2. By type of responsibility, separating balances owed by insurers from those owed by patients, as each requires a completely different follow-up approach.

Next, establish your baseline figures. Common benchmarks suggest that, for most outpatient care centers, the average collection period (days in accounts receivable) should fall between 30 and 40 days, and no more than 15–20 percent of total accounts receivable should be more than 90 days old. Your own targets may vary depending on your specialty and payer mix; however, document your current status so that you can measure progress leading up to December.

Step 2: Triage by Deadline, Value, and Likelihood

Managing accounts simply in chronological order is a common mistake. A smarter approach involves prioritizing each outstanding account based on three factors:

Deadline-related risk: Claims approaching the deadline for submission or for filing an appeal must be addressed first, as missing such a deadline results in the complete loss of the opportunity to recover the funds.
Monetary value: Claims with a high balance offer a greater potential for fund recovery relative to the time spent by staff.
Likelihood of payment: Claims with a clear, resolvable issue should take precedence over those for which no explanation is provided.

Know the deadlines before you begin. Generally, Medicare requires claims to be submitted within one calendar year of the date the service was provided. For New York Medicaid (under the fee-for-service model), initial claims are typically required within 90 days, with an additional 60-day window to correct and resubmit any returned claims. Contracts with private insurers vary significantly, and managed care plans set their own rules; therefore, it is essential to review each participation agreement rather than applying a generic deadline. Identify all accounts with 30 days or less remaining until their deadline and prioritize them accordingly.

Step 3: Identify the Root Cause of Each Unpaid Claim

An outstanding claim is a symptom. The underlying cause typically falls into one of several categories, each requiring a different solution:

1. Unbilled or held: charges stuck in a coding queue, missing documentation, or an unsigned note.
2. Rejected prior to processing: formatting, demographic, or identification errors that prevented the claim from reaching the payer’s review stage.
3. Denied: the payer processed the claim but refused payment for a specific reason.
4. Underpaid: a payment was made, but for an amount less than the contracted rate.
5. Pending with no response: submitted, but with no confirmation of receipt or final resolution.
6. Awaiting patient payment: the insurer has already made its payment, and the remaining balance is the patient’s responsibility.
7. Coordination of benefits issues: the claim was billed to the wrong payer first, or secondary coverage was not processed.

Label each account with one of these causes. This labeling process transforms an overwhelming list into a set of manageable work queues.

Step 4: Work the Payer Side Systematically

1. Unanswered claims: First, check the status of the claim via the payer’s portal or the clearinghouse. If there is no record of the claim, resubmit it immediately and retain proof of the original, timely submission; this documentation can protect you against a denial based on late filing.
2. Rejected claims: These are the easiest to resolve. Correct the error and resubmit the claim that same day. Unnoticed rejections are a common reason why accounts remain outstanding for long periods without anyone realizing it.
3. Denied claims: Group denials by reason code and payer. Many denials share a common cause such as a lack of authorization, loss of eligibility, or coding discrepancies meaning a single correction can often lead to the processing of dozens of claims. For denials that are truly the result of a payer error, submit a well-documented appeal, including the claim, relevant records, and a clear explanation of why the denial was incorrect. Submit appeals according to the payer’s required method and keep track of the submission date.
4. Underpayments: Compare the payment received against the fee schedule stipulated in your contract. Facilities that skip this step often lose out on revenue without realizing it, as a payment recorded in the system without an accompanying denial rarely triggers an alert. Dispute these discrepancies with the payer, citing the contractually agreed-upon rate in your request.
5. Coordination of benefits: Determine which payer is the primary one, update the record, and rebill accordingly. If the patient has not responded to inquiries regarding their coverage, contact them directly.
    

Step 5: Fix the Front-End Problems That Created the Backlog

Recovering old claims is only half the job. If the same errors continue to generate new outstanding balances, the backlog of cases will simply reappear by spring. As you work through the pending tasks, identify recurring root causes and address them at the source:

1. Verify eligibility before every visit not just for new patients.
2. Confirm prior authorization requirements for scheduled procedures and diagnostic imaging tests.
3. Review (screen) claims before submission to detect coding or formatting errors.
4. Follow up on denied claims daily, rather than weekly.
5. Prepare now for the updates to code sets and payer policies taking effect in January, ensuring that your first claims of 2027 are submitted error-free.

A brief monthly review of the top five reasons for claim denials can reveal patterns that might otherwise go unnoticed.

Step 6: Collect Patient Balances Before the Year Closes

Patient financial responsibility has increased in many medical practices as deductibles and coinsurance have risen. Furthermore, these outstanding balances age quickly, as patients rarely volunteer to make payments on their own initiative. Several practical tactics can help:

1. Send a clear statement that includes a plain-language explanation of what insurance covered and the remaining balance.
2. Offer payment options via online portals or text messages, making it possible to complete a payment in less than a minute.
3. Point out that the end of the year serves as a natural deadline especially for patients with Flexible Spending Accounts (FSAs), as these funds may not carry over to the following year.
4. Propose structured payment plans for large balances; a small monthly payment is preferable to receiving no payment at all.
   Follow up on larger balances via telephone, using a polite script focused on resolving the issue rather than applying pressure.

Ensure compliance with the rules established by each payer or program. For example, providers generally cannot bill Medicaid beneficiaries for amounts covered by the program; therefore, verify the actual patient responsibility amount before sending a statement.

Step 7: Decide What to Adjust, Write Off, or Send to Collections

Some balances may prove unrecoverable, and keeping them on the books indefinitely distorts your financial reports. Conversely, writing off a balance too soon means forfeiting potential revenue. Establish clear criteria:

1. Do not write off claims that are still subject to an appeal process or that fall within the timeframe for filing a request, provided there is a reasonable likelihood of collection.
2. Adjust balances that exceed limits defined in contracts, in accordance with the terms of those agreements.
3. Write off small-balance accounts only in line with a documented policy that is applied consistently.
4. Consider pursuing collections for patient-responsibility balances that remain unpaid after a set number of notifications and calls while always ensuring compliance with regulatory requirements.
5. Document every decision so that it can be justified to auditors, partners, or your accountant.

Since many practices or care centers close their accounts at the end of the year, consult with your accountant regarding the appropriate timing and procedure for carrying out these write-offs.

A Ten-Week Recovery Plan
 

Assign each stage to a named owner and hold a brief weekly check-in. Shared accountability matters more than any single tactic.

Metrics to Track as You Go

Measure progress on a weekly basis so you can make quick adjustments:

1. Total accounts receivable (A/R) and the percentage that are more than 90 days old
2. Days in accounts receivable (A/R)
3. Amount recovered from claims that are more than 90 days old
4. Clean claim rate (claims accepted on the first attempt, without errors)
5. Denial rate and the primary reasons for denials
6. Net collection rate

If the percentage of accounts more than 90 days old has not decreased by the time you reach the midpoint of your planned timeline, look for potential bottlenecks: insufficient staff hours, an unresponsive payer, or a recurring denial that has not been addressed at its source.

When It Makes Sense to Bring in Help

Many medical practices know exactly what needs to be done, but they lack the time to carry it out. Reception and billing staff are already overburdened, and following up on old accounts receivable requires the kind of meticulous, patient work that is all too easy to put off. Delegating the follow-up of outstanding accounts receivable to an external billing partner frees up your internal team, brings in experts in managing denials and appeals, and delivers results more quickly—especially as the December 31st deadline approaches.

The Takeaway

Accounts receivable aging rarely improves on its own. Practices that successfully recover the most revenue approach this process as a project: they generate an accurate accounts receivable aging report, prioritize items based on age and value, identify the root cause of each stalled claim, manage each work category systematically, collect outstanding patient balances before year-end, and address the underlying issues that led to the accumulation of unpaid accounts. Ten weeks of focused effort can reduce balances that are more than 90 days old, improve cash flow, and ensure a much more organized start to 2027.

ESOFTX, Inc., a medical billing company based in Levittown, New York, helps practices recover aged accounts receivable, resolve claim denials, and strengthen revenue cycle performance. If you would like a complimentary review of your current accounts receivable aging report, our team is ready to assist you.