According to HFMA’s 2025 analysis of healthcare claims data, initial claim denial rates climbed to nearly 12% in 2024, a 2.4% increase year over year. For every 100 claims your practice submits, 12 come back denied on first pass. That means resubmissions, delayed payments, and staff hours spent fixing what should have been paid the first time. AR follow up is how you track down these unpaid insurance claims and patient balances until you collect what you’re owed.
Practices that let claims sit without follow up watch their money disappear. Strong AR processes keep days in accounts receivable under 40 days and recover over 95% of what payers owe. This guide breaks down the AR follow up process, what actually works when dealing with payers, the problems you’ll run into, and how to measure whether your efforts are paying off.
AR follow up starts when money owed to your practice doesn’t arrive within expected timeframes. This includes outstanding insurance claims submitted but not yet paid, patient balances for deductibles and co-pays, unpaid denials being worked for resubmission, pending payment plans with patients, and credit balances from overpayments needing resolution.
Most AR follow up focuses on insurance claims since these typically represent 70-80% of practice revenue, tracking claims beyond the payer’s standard 14 to 30 day window, contacting insurers to determine status, fixing problems, and pursuing payment until resolved.
This differs from external collections. AR follow up is your internal effort using normal billing channels, payer contacts, patient statements, collection calls, and payment plan monitoring. External collection agencies only come into play after your AR team exhausts internal attempts and accounts become unlikely to collect through standard processes.
AR follow up runs in three phases. Most practices that struggle with aging AR either skip one of these phases or don’t connect them properly.
Your aging report shows which claims follow up need attention. These reports break unpaid claims into time buckets:
Your team calls the payer, checks their online portal, or pulls status through your clearinghouse. The payer tells you one of several things: they never got the claim, they’re waiting on more information, it’s processing, or it’s denied. Document everything. Write down the date, who you spoke with, their reference number, and what happens next.
Denials require more work. Pull the denial code, figure out what went wrong, fix the error, and get ready to resubmit or appeal. Missing prior authorization? Incorrect procedure code? Patient eligibility issue? Each denial reason has a different fix, and you’re usually working against a deadline to get it corrected.
When the payer approves and sends payment, you post it and close the claim. Denied claims go through your appeal process if the denial is worth fighting. Some claims hit a wall after multiple follow up attempts, payer won’t budge, the documentation doesn’t support the service, or the cost to keep pursuing exceeds the claim value. Those go to management to decide whether to appeal one more time or write off.
Every billing team faces the same obstacles. Payers don’t make AR follow up easy, and the problems are predictable. The practices that succeed have developed specific workarounds for each common roadblock instead of fighting the same battles repeatedly.
Claims come back denied for wrong CPT codes, missing modifiers, or insufficient documentation to support the service billed. By the time you catch it, you’re already 30-45 days out.
Catch this before submission. Run claims through scrubbing software. Have your coders do peer reviews on complex cases. Track your denial patterns, if you’re getting the same denial repeatedly, fix the problem at the source instead of correcting it claim by claim.
Payers love to ask for “additional documentation” without specifying what they need. Your staff wastes time sending records that don’t answer the payer’s actual question.
Call the payer before you send anything. Get specific. “Which progress note?” “What date of service?” “Are you looking for the H&P or the operative report?” Send exactly what they ask for with a cover sheet that references the request date and representative name.
You call the payer and sit on hold for 45 minutes, only to reach someone who can’t help and transfers you to another 30-minute hold. This burns hours of staff time every week.
Use payer portals first for status checks. Save phone calls for claims that need actual problem-solving. Document every call attempt with timestamps. After three failed contact attempts, escalate to your payer rep if you have one.
Stop treating all claims the same. Your follow up schedule should match the urgency of each aging bucket:
| Aging Bucket | Follow Up Action | Why This Matters |
|---|---|---|
| 0-30 Days | Check your remittance reports weekly but don't waste time calling payers. | Most claims pay within this window without intervention. |
| 31-60 Days | Make your first contact. Call or check the payer portal to confirm they received the claim and it's processing. | This is your initial status check to catch problems early. |
| 61-90 Days | Weekly follow up calls minimum. Escalate to supervisor level at payers if you're getting nowhere. | This is where money gets lost. Claims need aggressive attention before they age into write-off territory. |
| 90+ Days | Daily attention. You're racing against timely filing deadlines. | Every day you wait is a day closer to permanent write-off. Most payers have filing limits at 90-120 days. |
Focus your staff time on the 60-90 day bucket. That’s where you get the best return on effort, claims are old enough to need intervention but young enough that recovery is still likely.
AR follow up isn’t optional anymore. With denial rates pushing 12% and payers taking longer to process claims, practices without structured follow up processes are in danger. Practices with strong AR management collect 9% more in the first 30 days and maintain days in AR under 40. Those without it on the other side watch claims stack up past 90 days into write-off territory.
Start with the basics, run your aging report, identify claims in the 60-90 day bucket, and assign someone to make calls. Also, make sure to track your days in AR and percentage over 90 days every month.
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