If your practice needs help recovering unpaid insurance claims, the realistic options are a medical billing company that runs accounts receivable recovery projects, a revenue cycle consultant who audits the backlog and works it alongside your staff, your clearinghouse’s claim follow-up service, or a healthcare collection agency for the patient-balance portion. Whoever you choose should work inside your existing practice management system, sort the backlog by deadline and dollar value before touching a single claim, and report what was recovered claim by claim. The clock matters more than the vendor does: under CMS rules Medicare allows 12 months from the date of service to file a claim, commercial payers commonly allow 90 to 180 days, and appeal windows are separate and often shorter. This guide covers what’s actually in a backlog, how to prioritize it, who can help, and what to ask before you hire anyone.
Many practices are sitting on money they’ve already earned. It shows up on the aging report as claims that are 90, 180, or 365 days old, and after a while it starts to feel like a number nobody expects to collect. Some of it truly is lost, but a meaningful share of old A/R can often still be recovered if it’s worked in the right order and before the remaining deadlines close.
Understand what’s actually in the backlog
The first step is to stop looking at A/R as one big number. An aging report breaks outstanding claims into buckets, usually 0 to 30 days, 31 to 60, 61 to 90, 91 to 120, and over 120 days. The older buckets are where recoverable money is most at risk.
Within each bucket, claims generally fall into a few groups:
- Claims that were never received by the payer, often because a rejection at the clearinghouse was never worked
- Claims that were denied and never corrected or appealed
- Claims that were paid incorrectly or underpaid
- Claims pending with the payer for more information, such as records or an itemized bill
- Balances that belong to the patient after insurance paid its share
Each group needs a different action, so sorting the backlog this way is what turns it from an overwhelming number into a work plan.
Know your deadlines
Every payer has rules about how long you have to file a claim, correct it, and appeal a denial. Under CMS rules Medicare generally allows claims to be filed up to 12 months from the date of service, and commercial payers often set shorter limits, commonly 90 to 180 days, that vary by contract. Appeal windows are separate and also vary by payer.
Because these windows are different for every payer, the backlog should be prioritized with them in mind. A claim that’s close to a deadline needs attention before a newer claim with more time left.
Work the highest-value claims first
Not every old claim is worth the same effort. A practical approach is to sort by dollar amount and deadline, then work the largest balances that are still within a filing or appeal window first. Small balances with no realistic path to payment may be better written off with a documented reason, so the team’s time goes where it can actually recover money.
Find out why each claim is stuck
For every claim, the key question is why it hasn’t been paid. Checking the payer portal or calling the payer usually answers it. Sometimes the fix is as simple as resubmitting a claim the payer never received, and sometimes it means gathering records, correcting codes, or writing a formal appeal.
When claims are resubmitted or appealed, keep proof of timely filing, such as clearinghouse acceptance reports. That documentation is often what gets an old claim paid when a payer says it was filed late.
Don’t forget underpayments
A claim that was paid isn’t always a claim that was paid correctly. Comparing payments against your contracted rates can reveal underpayments that are still eligible for an appeal. These are easy to overlook because the claim shows as closed.
Who can help, and how they’re paid
Most practices don’t have spare staff to work a backlog on top of current claims, so the work is usually handed to one of these:
- A medical billing company that takes on A/R recovery as a project. Many bill it as a percentage of what they recover, and because old claims take more work than current ones, that percentage is commonly higher than a standard billing rate, often in the 10 to 20 percent range in published pricing. Some charge hourly or a flat project fee instead.
- A revenue cycle consultant who audits the backlog, sorts it, and either works it or directs your team through it. This fits practices that want to keep the work in-house but need a plan and oversight.
- Your clearinghouse, if it offers claim status and follow-up services. These tend to be limited to tracking and resubmission rather than appeals.
- A healthcare collection agency for balances that belong to patients after insurance has paid. Agencies work on contingency, commonly 25 to 35 percent of what they collect, and should never be used for the insurance side of the backlog.
Whoever you hire, ask the same questions you’d ask any billing vendor: who will work the claims, whether they work inside your system, how they prioritize by deadline, what they report, and whether they’ll sign a Business Associate Agreement. Our guides on in-house vs. outsourced collections and how much outsourced medical billing costs cover the pricing models in more detail, and Elevate’s A/R recovery service runs this kind of project inside your existing software.
Stop the backlog from rebuilding
Clearing old A/R helps cash flow right away, but the backlog will come back unless the cause is fixed. That usually means working denials and rejections every week, following up on claims at set intervals instead of waiting, and tracking days in A/R and the share of A/R over 90 days as regular numbers the practice watches.
Recovering old A/R works best as a focused project, sometimes called an A/R cleanup or recovery effort, run alongside the day-to-day billing so the current claims don’t fall behind while the old ones are being worked.