An accounts receivable report tells you what remains unpaid. It does not always tell you what to do next. A claim might be awaiting payer processing, missing documentation, sitting in a rejection queue or carrying a balance that was posted incorrectly. Treating every open balance the same way wastes time and can leave urgent work untouched.
As the final quarter of 2026 begins, private practices have an opportunity to organize outstanding claims before year-end. A useful medical billing A/R cleanup starts with accurate balances, clear deadlines and a specific next action for each account.
1. Start with a reliable aging report
Run your report as of a recorded date and separate insurance balances from patient balances. Use consistent aging buckets, such as 0–30, 31–60, 61–90, 91–120 and over 120 days. Confirm whether your system ages accounts from the service date, billing date or another event before comparing reports.
Check for unposted payments, unapplied cash, duplicate charges and credits. A large open balance may reflect a posting problem rather than an unpaid claim. Keep credits visible for separate review instead of allowing them to hide outstanding debit balances.
2. Prioritize deadlines before age alone
The oldest claim is not automatically the most urgent. A newer claim near its filing deadline may need attention before an older claim with an active appeal.
Record the applicable initial filing, corrected-claim and appeal deadlines separately. Verify them against the payer’s current requirements and your contract rather than using one deadline for every insurer.
For Medicare fee-for-service, CMS generally requires claims to reach the correct Medicare Administrative Contractor within one calendar year after the date of service. The details and limited exceptions matter; this is not a universal commercial-payer deadline. Consult CMS guidance on timely filing for the Medicare rule.
Preserve submission and acceptance records. An internal note that a claim was sent is not the same as evidence that the payer received it.
3. Separate rejections, denials and pending claims
Give each account a status that supports the next action. A clearinghouse rejection may require a corrected submission. An adjudicated denial may require a correction, records or an appeal. A claim already pending with the payer may need a status inquiry rather than another submission.
Read the remittance details instead of relying on a short label in the billing system. CMS explains how claim adjustment reason codes and remittance advice remark codes communicate adjustment information in its payment and remittance advice guidance. Review the codes together with the payer’s explanation and instructions.
Avoid resubmitting every unpaid claim as a new claim. Check the existing claim’s status and follow the payer’s correction or appeal process to reduce unnecessary duplicate submissions.
4. Build a work queue with clear ownership
For every account selected for follow-up, document:
- Payer and claim reference number
- Date of service and outstanding balance
- Current status and reason for nonpayment
- Applicable deadline and supporting evidence
- Last action, response and reference number
- Next action, assigned owner and follow-up date
Keep these records in approved practice systems. Use aggregate information for management reporting when patient details are unnecessary.
For example, “called payer” is an incomplete handoff. “Payer requested the operative report; records team owns submission by Friday; billing will confirm receipt next week” makes the next step clear.
5. Review paid claims for underpayments
A paid claim can still have an unresolved balance. Compare the allowed amount and payment against the applicable contract or fee schedule, taking account of patient responsibility and legitimate adjustments.
Investigate unexpected reductions before marking them as contractual adjustments. Distinguish a genuine underpayment from a posting error, coordination-of-benefits issue or correctly assigned patient balance. Track disputes through the payer’s required process and deadlines.
6. Validate patient balances before sending statements
Before contacting a patient, confirm that insurance payments, secondary coverage and applicable adjustments have been processed correctly. Review disputed balances and existing payment arrangements so the next communication reflects the account’s actual status.
Do not automatically transfer every payer denial to the patient. Responsibility depends on the benefit, contract, applicable requirements and circumstances of the service. Route uncertain cases for review.
Use clear statements and a simple way for patients to ask questions. Consistent, accurate communication is more useful than repeated notices about a balance that has not been reconciled.
7. Measure resolution, not just activity
Calls made and accounts touched measure effort. They do not establish how much revenue was recovered. Review payments received on worked accounts, unresolved deadline risks, pending appeals and the reasons balances remain open.
Track the share of A/R over 90 days using a consistent report definition. If older A/R falls, determine whether the change came from payments, corrections or approved write-offs. A lower balance alone does not prove improved collections.
A practical four-week cleanup plan
- Week 1: Reconcile the report, identify deadline risks and assign owners.
- Week 2: Resolve submission errors and obtain missing documentation.
- Week 3: Follow up on denials, appeals and potential underpayments.
- Week 4: Confirm outcomes, review remaining barriers and update recurring workflows.
Continue checking urgent deadlines throughout the month. Use the weekly sequence to organize work, not to delay time-sensitive claims.
Keep the same problems from returning
Group recurring issues by cause: eligibility, coding, missing records, authorization, submission or payment posting. Assign a process change to each major pattern. For authorization-related issues, see our practical guide to preventing prior authorization denials.
Year-end cleanup should leave your practice with a manageable follow-up routine as well as a more accurate report. Medical Accounting and Billing Services supports practices with medical billing, A/R follow-up and revenue cycle management. Contact MABS to discuss your outstanding claims and billing workflow.
