Separate insurance and patient balances
Insurance A/R can include claims awaiting adjudication, corrections, documentation, or appeal. Patient A/R can include valid deductibles, coinsurance, noncovered services, and approved payment-plan balances.
A rejected or denied claim does not automatically make the full charge the patient's responsibility. Review the explanation of benefits, payer agreement, billing records, and applicable rules before transferring a balance.
Use clear aging definitions
State whether aging begins with the service date, invoice date, or payment due date. An invoice can be old without being overdue under its terms. Use distinct buckets and report only the remaining balance after applied payments and adjustments.
Hypothetical example: A practice bills $600, posts a $150 contractual adjustment and a $350 insurer payment, and records $100 as valid patient responsibility. Patient follow-up should address the verified $100, not the original charge.
Match the action to the cause
Correct claim data for a rejection, supply documentation when required, review a denial, and explain verified patient responsibility clearly. A generic payment reminder will not fix an unresolved insurance error.
Payment initiation, receipt, posting, and bank reconciliation are separate events. Check recent and unapplied payments before outreach.
Metrics and data handling
Track outstanding insurance and patient balances separately, defined aging percentages, denial reasons, arrangement completion, and reconciliation exceptions. State denominators and reporting periods.
For HIPAA-covered practices and relevant service providers, apply the appropriate business associate and minimum necessary requirements when using collection support.
Sources: ADA EOB guidance and HHS guidance on collection agencies.