Most providers we meet have a meaningful slice of AR sitting past 120 days. Some of it is denied managed care claims that bounced off the third appeal letter. Some is third-party liability waiting on a settlement that never comes. Some is workers' comp held up in a fee-schedule dispute. The common thread: the in-house billing team has run out of moves, and the dollars are just sitting there.
This is the playbook we run when a healthcare CFO calls us to attack that aged AR. It's a 90-day window because that's how long it takes to triage a real inventory, work the recoverable accounts hard, and prove out a recovery curve. Anything shorter is theater. Anything longer and the receivables age out of statute.
Days 1–10: Triage, don't chase
The single biggest mistake providers make with aged AR is treating it as one undifferentiated pile. It isn't. A 270-day workers' comp claim and a 270-day commercial denial need completely different recovery strategies, and the operator who works both the same way will fail at both.
The first ten days should be pure triage. We segment the entire aged inventory into cohorts:
- Managed care denials — by payer, by denial reason code, by dollar value
- Workers' compensation — by state and jurisdiction
- Third-party liability and MVA — by case status (open, settled, pending lien)
- Self-pay — segmented by likely insurance discovery yield
- Out-of-network and No Surprises Act — eligible for IDR vs. not
- Closed-loop accounts — patient deceased, facility closed, bankruptcy, etc.
Each cohort has a different recovery rate, a different playbook, and a different cost-to-collect. The triage step exists to match dollars to plays, not to start working accounts at random.
Days 11–30: Hit the high-value cohorts first
Once segmentation is done, the next 20 days go to the cohorts with the highest dollar-weighted recovery probability. For most provider inventories that means:
1. Denied commercial claims with appeal rights still open
Many "aged" denials are not actually dead. They sit at appeal level 2 or 3 with the payer's clock paused while internal billing teams move on. A senior attorney can reopen those appeals, attach the right medical necessity documentation, and force the payer back to the table. This is the work we do under Insurance Follow-Up & Managed Care.
2. Open TPL and MVA cases with pending settlements
If your patient has an active personal injury claim, the bill is not lost — it's just sitting behind the attorney negotiation. The right play is to perfect a medical lien against the settlement and put a single point of contact in place with the patient's PI attorney. We cover the full lifecycle under Medical Lien & LOP Management.
3. Workers' comp with fee-schedule disputes
Most carriers underpay by 5–15% on workers' comp claims and bank on providers not appealing. State-specific fee schedules and EOR navigation recover a meaningful percentage when worked by someone who knows the regime. See our Workers' Compensation practice.
Days 31–60: Escalation, not repetition
By day 30 the easy wins have either landed or are on their way. What's left is the genuinely hard work — the accounts where the payer has said no, the case where the carrier won't budge, the denial that's already been through three rounds of appeals.
This is where most vendors stop. It's also where the dollars are. Here's what changes in the next 30 days:
- Pre-litigation demand letters from in-house attorneys. A demand letter from a law firm reads differently than a sixth appeal from a billing analyst. Payers know it.
- No Surprises Act IDR filings for eligible out-of-network claims. The federal IDR process has a hard timeline; most providers leave eligible claims on the table because the billing team doesn't know they qualify.
- ERISA appeals for self-funded plan denials with bad-faith handling patterns.
- Lien enforcement for TPL cases where the settlement has happened but the disbursement is being delayed.
- Arbitration demands on contracts that include arbitration clauses payers are quietly hoping you won't invoke.
None of this is about volume. It's about matching the specific legal or regulatory lever to the specific stuck account. That's what attorney-driven recovery actually means.
Days 61–90: Measure, report, decide
By day 60, an aggressive recovery program has produced enough data to know which cohorts paid off, which ones didn't, and which ones need a different approach in the next quarter.
The metrics that matter at the 90-day mark:
- Net cash collected from accounts originally aged 120+ days at intake
- Recovery rate by cohort (managed care vs. WC vs. TPL vs. self-pay)
- Cost-to-collect by cohort — what did each dollar of recovery actually cost
- Inventory that should be written off with confidence — the genuinely unrecoverable, now identified
- Statute-of-limitations exposure on remaining inventory — what's about to age out
The 90-day mark is also the right moment to make a structural decision: should the recovery work continue in-house, get outsourced as an Extended Back Office engagement, or shift to a Joint Venture Servicing arrangement where MAS takes on the operational and compliance burden in exchange for a share of recovery?
Most aged AR isn't bad debt. It's good debt that hasn't met the right recovery model.
What this looks like for your organization
If you're a healthcare CFO reading this and your AR over 120 days is north of a few million dollars, the math on attempting a 90-day attack is almost always in your favor. The downside is the cost of running the program. The upside is recovered cash that's currently sitting at zero on your balance sheet — and a structural fix to whatever caused the AR to age in the first place.
The first conversation is just a candid read. We'll look at your aging report, ask the right questions about your payer mix, and tell you honestly whether the inventory justifies the engagement. If it doesn't, we'll say so. If it does, we'll scope a pilot that pays for itself.
Talk to a senior attorney at MAS within one business day.