Aged accounts are outstanding patient accounts that are over 30 days. An important management tool that measures aged accounts is the accounts receivable report. The accounts receivable, or AR, report is designed to analyze the financial health of the medical office. Using the discharge date of the patient account, the AR report calculates the length of time it takes for medical claims to get paid.
When the AR report indicates that revenue has not been collected within 30 days of the patient's discharge date, this is a warning to management that there is a risk to the financial state of the medical office. Depending on the length of time the claim remains unpaid, management needs to make critical decisions on how to turn these accounts from an unpaid status to a paid status.
Most AR reports are set up to demonstrate aged claims in the following way:
0 - 30 days: Insurance claims should be billed within 72 hours of the discharge date. Claims unpaid during this period should be pending payment or denial from the insurance company. The electronic submission report should be reviewed daily to see which claims have been accepted and which have been rejected. Claims that have been rejected should be researched to find out why. Corrections should be made right away so the claim can be resubmitted. Initial contact with the insurance payers should also be made within the first 30 days. Follow-up for electronic claims should be made 7 days after the claim has been accepted and paper claims should be follow-up after 14 days.
31 - 60 days: Claims that remain unpaid within this period have the greatest chance of being paid. Payers are required to respond to medical claims within 30 days of receiving them. During this time, if the claim hasn't been paid, the payer is required to respond to the claim in some way. Usually you will receive a documentation with the following information:
- request for more information from the provider
- notification that more information has been requested from the patient
- notification that the claim needs further review
- the claim has denied
Medical claims are unique to accounts receivable in other industries due to timely filing restrictions set by insurance payers. Depending on the payer, the medical office may have as little as 30 days to up to 1 year to file a claim to the payer. This window of opportunity makes it more risky as the days pass for the claim to get paid at all.
61 - 90 days: Although unpaid claims between 31 - 60 days are easier to collect, unpaid claims between 61 - 90 days should be the number 1 priority. These claims are at risk for becoming uncollectable. This is a critical time for medical billers to make certain that unbilled claims are filed in order to meet timely filing deadlines or resubmit denied claims.
Over 90 days: Once claims have remained unpaid for over 90 days, the chances of being collected drop from 95 - 98% collectable to under 75% collectable. The longer a claim remains unpaid, the less chance it has to become paid. At this point in the revenue cycle, it is crucial to identify each claim based on its ability to get paid.
If the claim has been identified as uncollectable, it should be written off to prevent valuable time from being spent that could be used on collecting on collectable accounts. Of the claims identified as collectable, the claims that have been billed and denied should be corrected and resubmitted as a corrected claim or should be re-filed with as an appeal.