Aged accounts receivable (AR) is a silent cash-flow killer for small clinics. Whether due to claim denials, staff turnover, or inefficient follow-ups, unresolved AR beyond 90 or 120 days can strangle a clinic’s revenue cycle. The longer a claim sits unaddressed, the lower the chance of successful collection.
For small practices operating on thin margins, there’s no room for letting revenue slip through the cracks. This guide outlines a focused, 90-day sprint framework designed specifically for small clinics to close aged accounts receivable (AR), recover lost revenue, and restore financial stability—without overwhelming internal staff or overhauling your existing systems.
Understanding Aged AR in the Context of Small Clinics
Aged AR typically refers to outstanding insurance or patient balances that remain unpaid beyond 60, 90, or 120 days from the date of service or claim submission. For small clinics:
- Even a backlog of $20,000–$50,000 in aged AR can seriously impact cash flow.
- Delays often stem from claim rejections, eligibility errors, coordination of benefits, or patient non-responsiveness.
- While large health systems have accounts receivable (AR) teams and automation tools, small clinics must rely on focused planning, skilled staff, and smart prioritization to resolve backlogs.
The 90-Day AR Sprint Framework: Core Philosophy
This plan is a short-term intensive project with a clear goal: resolve, collect, or write off aged AR with justification—within 90 days. It’s structured to:
- Re-engage denied or ignored claims
- Categorize issues by root cause
- Establish account ownership and measurable targets
- Recover cash or close dead claims to clean up the accounts receivable (AR) ledger
The framework doesn’t require expensive tools—just consistent effort, smart segmentation, and accountability.
Phase 1: Prep and Prioritize (Days 1–10)
1. Extract the AR Aging Report
- Pull your AR aging report by payer, date of service, and aging buckets (e.g., 61–90, 91–120, >120 days).
- Ensure it’s cleaned of paid or duplicated claims to avoid wasted effort.
2. Segment the AR
Divide aged AR into three actionable categories:
- High-Value + High-Probability: Claims over a certain dollar value with good appeal potential.
- Pending Documentation: Claims stuck due to missing notes, authorization, or coding errors.
- Low-Probability / Low-Dollar: Likely write-offs unless grouped with larger patterns.
3. Assign Internal or External Resources
- Allocate ownership for each bucket—either internal billers, coders, or external accounts receivable (AR) cleanup vendors.
- If outsourcing, focus on HIPAA-compliant RCM partners with denial resolution experience.
Phase 2: Focused Recovery and Resolution (Days 11–60)
4. Tackle High-Yield Claims First
- Start with claims aged 60–120 days with a higher chance of payment (e.g., payers with good turnaround time).
- Verify coverage retroactively, gather missing documentation, and resubmit with corrected info.
5. Denial Management: Reopen, Appeal, or Close
Use denial codes to create appeal strategies:
- CO-16 (missing info) → Submit corrected claim
- CO-97 (non-covered service) → Check benefit limits or modifier usage
- Submit appeals with medical necessity justification or corrected coding.
- Track each appeal with expected turnaround dates.
6. Follow Up Aggressively
- Use a weekly touchpoint schedule for payer calls and portal checks.
- Maintain notes in your billing software to avoid duplicate follow-ups or wasted time.
- Document payer responses for compliance.
Phase 3: Reconciliation, Write-Offs & Prevention (Days 61–90)
7. Justify and Write Off Unrecoverable Claims
Not all accounts receivable (AR) is collectible. If a claim is beyond timely filing and cannot be appealed:
- Document the attempt
- Assign appropriate write-off code (timely filing, medical necessity denial, etc.)
- Avoid simply moving to patient responsibility without cause
8. Reconcile with Financial Reports
- Match your resolved accounts receivable (AR) with payments received or posted.
- Update your EHR/PM system to reflect closed balances, not just cleared reports.
- Cross-check against bank deposits to ensure posting accuracy.
9. Conduct Root Cause Analysis
Before wrapping the sprint, analyze:
- Top 5 denial reasons
- Common CPT/ICD code mismatches
- Payers with frequent rejections Use these insights to revise front-desk intake, coding protocols, or billing software rules.
Sustaining Clean AR Beyond the 90-Day Sprint
While this project resolves aged accounts receivable (AR) temporarily, clinics must implement preventive AR workflows to avoid future backlogs.
Best Practices for Ongoing AR Control:
- Set up weekly AR review meetings even post-sprint
- Monitor aging buckets in real-time, not just monthly
- Flag claims reaching 30 days without payer response
- Invest in claims scrubbing tools or clearinghouses with first-pass acceptance rates
- Educate front-desk and billing staff on denial-prone errors
Why Small Clinics Must Actively Manage Aged AR
Unlike larger systems, small clinics don’t have the luxury of delayed revenue. Every dollar sitting in aged accounts receivable (AR) represents:
- Unrealized income
- Increased patient dissatisfaction (if claims are dumped into patient responsibility)
- Compliance risks, especially if payer contracts require timely responses
Aged AR also affects your ability to:
- Invest in staff or technology
- Sustain operations during reimbursement delays
- Secure loans or funding based on cash flow health
When to Consider AR Cleanup Services
If your clinic:
- Has over $50,000 in aged accounts receivable (AR) across multiple payers
- Lacks in-house denial management expertise
- Sees repeated claim rejections for basic errors
- Can’t afford to redeploy front-office staff for backend AR tasks
…then consider short-term outsourcing to a specialized RCM vendor for AR cleanup campaigns.
Ensure the vendor provides:
- Daily status updates
- Detailed denial categories
- Appeal documentation trail
- Reconciliation reports at project completion
Key Takeaways
- Aged accounts receivable (AR) over 90 days drains small clinic revenue and requires intentional, short-term action.
- This 90-day sprint framework offers a systematic approach to categorizing, resolving, and closing aged claims.
- Focus on high-probability claims first, document everything, and don’t be afraid to write off dead accounts.
- Post-sprint, build a culture of preventive AR management to maintain revenue hygiene and long-term financial health.
Final Thoughts
Aged accounts receivable (AR) isn’t just a billing issue—it’s a reflection of your clinic’s operational health. With the right strategy, even small clinics can resolve old claims, prevent future denials, and create a sustainable revenue cycle that thrives.
The 90-day sprint is not a one-time fix—it’s a blueprint for transforming chaos into control.
