Medical Accounts Receivable Services

A denial isn't the end of a claim. It's the beginning of the recovery process. Each denied claim costs an estimated $25 to $30 to rework. Hospitals spent $19.7 billion on denied claim appeals in a recent year.

Our team categorizes every denial by root cause: eligibility errors, coding mistakes, authorization failures, timely filing violations, medical necessity challenges. Each denial category has a specific resolution path. We don't send generic resubmissions. Every appeal includes the exact documentation the payer needs to overturn the denial.

More importantly, we track denial patterns across your entire book of business. When we see the same denial reason appearing repeatedly from the same payer, we fix the upstream issue.

Most billing companies check claim status once and move on. Our A/R recovery team follows a structured, escalating protocol for every unpaid claim in your aging report.

Day 1-14: Acknowledgment verification. We confirm the payer received the claim electronically. If no acknowledgment is on file, we investigate whether the claim was rejected at the clearinghouse level, sent to the wrong payer ID, or lost in transmission. Claims that never reach the payer are the easiest to lose and the most common reason practices have mysterious aged balances.

Day 15-30: First status check. We pull the claim status from the payer's provider portal or 277 transaction. If the claim is processing normally, we document the expected payment date. If it's pending for additional information, we respond the same-day with the requested documentation.

Day 31-60: Active pursuit. Claims in this window get direct phone follow-up. Our team contacts the payer's claims department, documents the representative's name and reference number, and gets a specific resolution commitment. If the claim has been denied, we begin the appeal process immediately rather than waiting for the paper denial to arrive.

Day 61-90: Escalation. Unresolved claims are escalated to payer supervisors. We file formal written appeals with complete clinical documentation, corrected claim data, and supporting evidence. For Medicare and Medicaid claims, we initiate the formal redetermination process.

Day 90-120: Maximum pressure. Claims in this bracket are approaching many payers' timely filing deadlines for appeals. We exhaust all internal appeal levels, file complaints with state insurance departments when appropriate, and pursue every secondary and tertiary payer option. For Workers' Comp and auto accident claims, we contact adjusters directly.

Day 120+: Recovery assessment. Claims beyond 120 days have recovery rates below 30%, but that doesn't mean we give up. We evaluate each claim individually — some high-dollar claims are worth pursuing through external review or independent dispute resolution. Others need to be identified as uncollectable so your A/R aging report accurately reflects real expected revenue.

Denials get attention because they show up as zero-pay claims. Underpayments are more insidious because the claim shows as paid, but the amount is wrong. Studies estimate that 5% to 10% of all paid claims contain underpayments — and most practices never catch them.

Underpayments happen for several reasons. The payer applied the wrong fee schedule. A contracted rate increase wasn't loaded into the payer's system. Multiple procedure reduction rules were applied incorrectly. A modifier that should have increased reimbursement was ignored. The claim was processed as out-of-network when you have an active contract — a problem that proper credentialing and our OON negotiation team can address.

Go Medical Billing compares every payment against your contracted rates. When the allowed amount doesn't match what the contract specifies, we flag it and pursue the balance. For a mid-size practice, underpayment recovery alone can add $30,000 to $75,000 in annual collections — money that was already earned but never collected.

We also identify systemic underpayment patterns. If UnitedHealthcare is consistently paying 8% below your contracted rate for E/M codes in a specific plan tier, that's not a random error — it's a system configuration issue that affects every claim until it's corrected. We escalate these patterns to payer provider relations departments and track resolution through to completion.

You can't manage what you don't measure. Every month, we deliver a detailed A/R performance report that tracks the metrics that matter for your practice's financial health.

Days in A/R (DAR). The average number of days a claim sits before payment. Industry benchmark is 30 to 40 days. If yours is above 45, there's a process problem. We target getting every client below 35 days.

A/R aging distribution. The percentage of your total receivables in each bucket: 0-30, 31-60, 61-90, 91-120, 120+. A healthy practice keeps 85%+ in the 0-60 day range. We show you this distribution by payer so you can see exactly which insurance companies are paying slowly.

Net collection rate. What you actually collected versus what you were contractually owed (after adjustments). This is the single most important metric for practice revenue. A rate below 95% indicates systematic collection failures. Our target for every client is 96% or higher.

Denial rate and resolution rate. What percentage of claims are denied initially, and what percentage of those denials do we successfully overturn. The national average first-pass denial rate is 11.8%. Our clients average well below that because we prevent denials at submission, and we overturn the majority of denials that do occur.