Accounts Receivable (AR) Follow-Up

They overlap but solve different problems. AR follow-up is the broad pursuit of every unpaid or underpaid claim sitting in your aging buckets, including claims that are simply stuck in payer processing, never adjudicated, or paid below the contracted rate. Denial management is the focused work of overturning claims a payer has actively denied with a CARC/RARC reason. Most clients run them together and the two feed each other, but we can take on AR follow-up on its own if that is where your backlog is.

We do both. Some clients bring us in for a focused cleanup of a large aging backlog, often the 90-plus and 120-plus buckets that have been sitting, and others keep us on for continuous follow-up so AR never piles up again. A cleanup project is scoped to the claim volume and age of the inventory, and many clients move into ongoing follow-up once the backlog is cleared. We will be honest about which claims are still recoverable and which have passed timely filing.

We resolve claim status through payer portals, EDI 276/277 status transactions, and direct payer calls when a portal will not give a real answer, then take the next concrete action, whether that is a corrected claim, an appeal handoff, a reprocessing request, or escalation. Each open claim is worked on a cadence tied to its value and timely-filing window rather than touched once and forgotten. We document every contact, reference number, and payer commitment so there is a clear trail and no repeated dead-end calls.

We start with read or work access to your existing PM or EHR system, an aging report or AR snapshot, your payer mix, and any portal and clearinghouse logins, plus a signed BAA. From there we map your aging by payer, age, and value and agree on where to start, usually the dollars most at risk of timely-filing loss. How quickly we begin working claims depends mostly on how fast access is provisioned and the size of the backlog, and we will set a realistic start date with you rather than over-promise one.

You keep your system. We work as an extension of your office directly inside the EHR and practice-management software you already use, so notes, claim statuses, and adjustments live where your team expects to find them. We are comfortable across common platforms and clearinghouse portals, and if a payer interaction requires a specific portal we use it. There is no migration and no new tool for your staff to learn.

Underpayments are a quiet leak, because the claim shows as paid even though it was reimbursed below the contracted or expected rate. As we work AR, we compare payments against your fee schedule and payer contract terms to flag balances that were paid short, then pursue the difference through reprocessing requests or appeals. To do this well we need your contracted rates and fee schedules on file. For DME specifically that includes watching capped-rental sequences and modifier-driven pricing so partial or skipped rental payments do not slip by.

You get reporting on recovered AR and at-risk AR, with aging broken down by payer, age bucket, and value so you can see where dollars are moving and where they are stuck. We surface the claims approaching timely-filing deadlines, recurring payer patterns worth fixing upstream, and balances we believe are no longer collectible so nothing is hidden. The cadence and format of reporting are set with you during onboarding, and everything ties back to the same statuses recorded in your own system.

We do not publish flat rates, because the right structure depends on your specialty, payer mix, claim volume, the age and condition of the AR, and whether this is a one-time cleanup or ongoing work. After a short consult and a look at an aging snapshot, we scope a model that fits your situation. We will be transparent about what is realistically recoverable before you commit, rather than quoting a number that ignores how much of your backlog has already aged out.