Accounts Receivable Management
Your A/R Is Not a
Waiting Game. We Work It.
The average medical practice has 18 to 24% of its annual revenue sitting in accounts receivable at any given time. Most of it is recoverable. ProvidaRCM pursues every open balance aggressively, payer follow-up, denial appeals, aged claim recovery, and payment posting, until your A/R is clean.
A/R Aging Snapshot
Being Worked
SYSTEM:
Initializing live RCM synchronization...
Current (0-30d)
$84,200
31-60 days
$56,800
61-90 days
$33,100
91-120 days
$21,400
120+ days
$14,600
Total Open A/R
$210,100
$178,400
Estimated recoverable
95%
Target clean rate
Every Day a Claim Sits Unpaid, Recovery Gets Harder
A/R is not just a reporting metric. It is your earned revenue sitting in limbo, depreciating daily. The older a claim gets, the harder it is to collect, payer timely filing limits expire, documentation becomes harder to retrieve, and payers bank on practices giving up.
58d
Industry average days in A/R
The average medical practice lets claims sit nearly two months before serious follow-up begins. At that point, collection probability has dropped significantly and staff are chasing claims instead of preventing them.
22%
Of annual revenue sits in open A/R
For a practice billing $2M annually, that is $440,000 in earned but uncollected revenue at any point in time. The question is not whether you have an A/R problem, it is how much of it is still recoverable.
8%
Drop in recovery rate per week of aging
Claims older than 90 days have a 50% lower recovery rate than claims worked within 30 days. Every week of delay makes the problem measurably worse. ProvidaRCM works claims within 24 hours of denial or non-payment trigger.
31%
Of practices report aging A/R as their top revenue problem
In MGMA surveys, aging accounts receivable consistently ranks as one of the top three revenue concerns for medical practices, ahead of coding errors and ahead of payer contract disputes. It is the most tractable problem in the revenue cycle.
$140K
Average aged A/R recovered per new ProvidaRCM client in the first 90 days
When ProvidaRCM takes over an A/R that has been neglected or worked inconsistently, the first 90 days typically surface $140,000 or more in recoverable claims that practices had assumed were gone. These are real claims, from real payers, that simply needed the right follow-up.
We Treat Every Bucket Differently
Not all aged A/R is worked the same way. A 35-day claim needs a different action than a 90-day claim, different payer channels, different escalation paths, different documentation. ProvidaRCM applies the right strategy to every bucket.
Current Bucket: Prevention Focus
Claims 0 to 30 days old are managed proactively, clean submissions, eligibility confirmed, authorization in place. The goal is ensuring these never migrate to older buckets through process failures.
30-60 Day Bucket: Active Follow-Up
Claims in this range receive direct payer follow-up via phone and portal. If payer processing time is exceeded, we escalate to supervisor level. Denial reasons are documented for root-cause correction.
60-120 Day Bucket: Escalation and Appeal
Claims beyond 60 days receive formal appeals where applicable, peer-to-peer review coordination for clinical denials, and, for high-value claims, direct payer negotiation with documentation of each interaction and expected resolution timeline.
120+ Day Bucket: Recovery Assessment
Aged claims receive individual recovery assessment, filing limits checked, appeal windows verified, retroactive options evaluated. We pursue every recoverable claim and provide written analysis for those that must be written off, including reason and any secondary recovery options.
A/R Recovery Rate by Aging Bucket
ProvidaRCM client average, all payer types
| Aging Bucket | Strategy | Recovery Rate |
|---|---|---|
0-30 Days |
Clean submission + eligibility |
98.2% |
31-60 Days |
Active payer follow-up |
94.7% |
61-90 Days |
Formal appeal + escalation |
87.3% |
91-120 Days |
Peer-to-peer + negotiation |
72.1% |
120+ Days |
Recovery assessment + pursuit |
51.8% |
Recovery rate drops 8% per week of aging. Claims worked within 30 days recover at nearly twice the rate of claims worked after 90 days. Speed is the single most important variable in A/R management.
Every Open Balance. Every Week. No Exceptions.
ProvidaRCM runs a structured weekly A/R cycle that ensures nothing ages past 90 days without escalation. Every claim in every bucket receives the right action at the right time.
Daily
ERA Posting and Balance Identification
Every remittance posted. Outstanding balances identified and bucketed by age, payer, and denial type within 24 hours.
Days 1-30
Clean Claim Submission and Tracking
New claims submitted clean, tracked through clearinghouse, and confirmed received by payer. Pending claims monitored against expected processing windows.
Days 31-60
Active Payer Follow-Up
Direct payer contact via phone, portal, and fax. Every interaction documented. Supervisor escalation initiated when standard processing windows are exceeded.
Days 61-120
Formal Appeal and Escalation
Complete appeal packages submitted with clinical documentation, coding rationale, and payer policy citations. Peer-to-peer review coordinated for clinical denials on high-value claims.
120+ Days
Recovery Assessment and Reporting
Individual claim analysis, external review options evaluated, and written recovery report provided. Every claim has a documented resolution path.
Every A/R Category. Nothing Left Behind.
ProvidaRCM does not cherry-pick easy claims. We work every open balance in every A/R category, commercial payers, government programs, patient balances, and the aged claims most billing companies give up on.
Get Free A/R Audit →We review your last 90 days and identify exactly what is recoverable.
Insurance Underpayments
When a payer reimburses less than the contracted rate, most practices post the payment and move on. ProvidaRCM identifies every underpayment against your contracted fee schedule and files formal disputes with documentation of the correct reimbursement amount. Systematic underpayment patterns are escalated to contract renegotiation recommendations.
Contracted rate comparisonFormal dispute filingPattern identificationAll payer types
Denied Claims and Appeals
Every denied claim is worked through the full appeal process, eligibility corrections, coding review, clinical documentation appeals, and peer-to-peer review coordination. Our 87% appeal success rate means most denials we work get reversed. The ones that cannot be appealed receive a written analysis of why and what, if anything, can still be done.
All denial typesFormal appeal lettersPeer-to-peer review87% reversal rate
Aged Claims Recovery (12+ Months)
Most billing companies write off claims older than 120 days. ProvidaRCM goes back 12 months or more, assessing each claim's recoverability, filing deadline status, and appeal window. Claims within filing and appeal windows are pursued aggressively. Claims where deadlines have passed are analyzed for alternative recovery paths including secondary billing, patient responsibility transfer, and, where applicable, state insurance department complaints.
12+ month lookbackFiling limit auditAlternative recovery pathsWritten resolution report
Patient Balance Follow-Up
Patient balances that have not been resolved through our statement service receive escalating follow-up, reminder statements, payment plan offers, and final balance notices with clear escalation language. ProvidaRCM manages patient A/R to collection while maintaining patient relationships and HIPAA compliance throughout every interaction.
Multi-channel follow-upPayment plan offersEscalating noticesCollection-ready handoff
Secondary and Coordination of Benefits
Once primary insurance adjudicates, secondary insurance claims must be filed promptly with the primary EOB attached. ProvidaRCM manages the entire secondary billing workflow, filing, tracking, follow-up, and COB dispute resolution when secondary payers deny coordination of benefits improperly.
Secondary claim filingCOB dispute resolutionEOB attachment managementDual-eligible billing
Every Payer Has a Different Playbook
Medicare appeals follow a completely different process than commercial payer appeals. Medicaid varies by state. Self-funded ERISA plans have unique rules. ProvidaRCM applies the right strategy for every payer type.
Medicare and Medicare Advantage
Traditional Medicare follows a strict five-level appeal process from MAC Redetermination through Federal District Court. Medicare Advantage plans operate like commercial payers with plan-specific appeal rules. ProvidaRCM tracks every level and deadline.
MAC Redetermination through ALJ Hearing
Medicare Advantage plan-specific appeal portals
ADR documentation requests managed
Coverage determination requests filed when appropriate
Medicaid and Managed Medicaid
Medicaid appeal processes, timely filing limits, and covered services vary significantly by state. ProvidaRCM maintains current knowledge of Medicaid appeal procedures across all 50 states and all managed Medicaid plans operating in each state.
State-specific appeal processes and deadlines
Managed Medicaid plan-specific protocols
Retroactive eligibility verification for denials
Dual-eligible coordination managed across plans
Commercial and Self-Funded Plans
Major commercial payers, BCBS, Aetna, UHC, Cigna, Humana, each have specific appeal portals, documentation requirements, and escalation channels. Self-funded ERISA plans add a layer of complexity that requires ERISA-specific appeal language and, when needed, legal escalation options.
Payer-specific appeal language and channels
ERISA plan fiduciary appeal requirements
External review requests for eligible claims
State insurance department escalation when warranted
What ProvidaRCM A/R Management Delivers
Primary Outcome
95%
Clean A/R Rate Within 120 Days of Onboarding
The target for any well-managed A/R is less than 15 to 20% of total A/R in the over-90-day bucket. ProvidaRCM drives the vast majority of clients to a 95% clean rate, meaning 95 cents of every dollar billed is resolved within 120 days, through aggressive, systematic follow-up across every aging bucket.
Daily ERA posting and balance identification, nothing falls through
No claim ages past 30 days without an active follow-up action
Root-cause fixes implemented to prevent recurring patterns
We had $380,000 in A/R over 90 days when we started with ProvidaRCM. They recovered $266,000 of it in the first 90 days. I had been told that money was gone. It was not, it just needed someone willing to actually work for it.
CFO, Cardiology Practice, Pennsylvania
Days in A/R
35d
Average Days in A/R, ProvidaRCM Clients
Down from the 58-day industry average. Faster resolution means better cash flow and less revenue at risk in the aging pipeline at any given time.
Aged Recovery
$140K
Average Aged A/R Recovered Per New Client in 90 Days
When ProvidaRCM audits a practice's A/R on onboarding, the average aged recovery in the first 90 days is $140,000. These are claims the practice had stopped working, not because they were uncollectable, but because nobody had the time to pursue them.
Claims 90 to 365 days old assessed individually
Filing and appeal windows audited before pursuit
Denial Reversals
87%
Of Appealed Denials Successfully Reversed
When ProvidaRCM files a formal appeal, 87% are ultimately paid. This rate reflects payer-specific appeal strategy, complete clinical documentation, and persistent follow-up through every appeal level until resolution is reached.
A/R Management Works Best as Part of Complete RCM
Recovering aged A/R is most powerful when paired with front-end processes that prevent claims from aging in the first place. ProvidaRCM manages the entire cycle.
Medical Billing
Clean claims submitted correctly the first time, reducing the volume of denials that feed the A/R aging pipeline.
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Denial Management
Systematic denial recovery with root-cause fixes that stop recurring patterns from inflating the aging A/R bucket every month.
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Patient Statements
Professional statement processing that resolves patient balances before they migrate to the A/R aging report.
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Eligibility Verification
Pre-appointment eligibility checks that eliminate the largest source of front-end denials that fuel A/R growth.
Learn more