When practices review their lost revenue, they often expect to find a pile of denials. More often, they find claims that were never denied at all. They were simply never paid, and nobody followed up until it was too late.
How a claim "ages out"
Every payer sets a timely filing limit: the window in which a claim, a corrected claim or an appeal must be submitted. Medicare generally allows 12 months from the date of service. Commercial payers often allow much less, commonly 90 to 180 days, and the limits for corrected claims and appeals can be shorter still. Once the window closes, the money is usually gone for good.
Claims age out for predictable reasons:
- No response from the payer. The claim was received but is pending, lost or waiting for information, and nobody checks its status.
- Rejections that never reached anyone. A clearinghouse rejection is not a denial. If it sits unworked in a report, the payer never received a valid claim.
- Requests for information. The payer asked for records or an itemized bill, and the letter went unanswered.
- Underpayments. The claim was paid, but for less than the contract allows, and nobody compared payment with the fee schedule.
- Too many claims, not enough time. Staff work the newest or easiest claims first, so older, harder claims slip further behind.
What a structured follow-up process looks like
Work every claim on a schedule
Review open claims by age bucket (0 to 30, 31 to 60, 61 to 90 and over 90 days) every week. Any claim without a payer response after about 30 days should get a status check by portal or phone.
Prioritize by value and deadline
Sort each bucket by dollar amount and by how close the claim is to its filing limit. A large claim that is two weeks from its deadline comes before a small claim that was submitted yesterday.
Work by payer
Grouping claims by payer lets one person resolve several claims in a single call or portal session, and patterns become obvious: if one payer is holding many claims for the same reason, that is a process problem to fix.
Document every touch
Each follow-up should record what was done, what the payer said and the next action date. That way no claim depends on one person's memory.
Check payments, not just denials
Compare every payment with the expected allowed amount. Underpayments are easy to miss and can be appealed if you catch them in time.
Track the right metrics
Watch days in A/R, the percentage of A/R over 90 days, and how many claims are written off for timely filing. The last number should be close to zero.
The result
A structured process turns A/R follow-up from a backlog into a routine. Claims are resolved while they are still collectible, and the problems that cause delays are fixed at the source. If your aging report has grown beyond what your team can work, our A/R follow-up services can clear the backlog and keep it from coming back.
