ASC accounts receivable is the money a surgery center has billed for completed cases but has not yet collected from payers or patients. Most of it should turn into cash within about five weeks. Claims that pass 90 days get harder to collect every week, and many cross a filing or appeal deadline before anyone works them.
An aged claim is not a lost claim until its last deadline passes. Surgery centers clear aged claims in a fixed order: clean the A/R, sort claims by why they are unpaid, map each claim’s deadline, rank the list by value and urgency, and then work each claim to payment. Only claims past every deadline should reach a documented write-off.
This guide covers that recovery process in seven steps, then explains how to stop new claims from aging.
Why ASC Claims Age Past 90 Days
Most aged surgery center claims trace back to a few breakdowns. On the front end, missed eligibility checks and demographic errors send claims back before the payer ever reviews the case, which is why benefits verification matters for every scheduled procedure.
Authorization gaps are the other front-end cause. When the surgeon performs a different or extended procedure than the one approved, the claim stalls unless the authorization is updated quickly.
In the middle of the cycle, operative notes are dictated late, coding or modifier errors slip through, and implant invoices never reach the claim. Our guide to ASC coding strategies covers how to close these gaps.
The rest happens after submission. No one checks the claim in its first 30 days, denials are posted but never worked, and balances never move to the secondary plan or the patient.
“The older claims are, the less likely they are to get paid.”
Patricia Smith, MBA, Director of Revenue Consulting, SYNERGEN Health, in For The Record
Healthy ASC A/R Benchmarks
Before recovery starts, know what good looks like. A Becker’s KPI review puts the industry standard near 35 days in A/R and keeps A/R over 90 days below 15% to 20% of total A/R.
The older buckets need their own limit. An industry benchmark shared in Same-Day Surgery suggests keeping less than 10% of A/R older than 120 days, and reviewing the aging report every month.
“You want to look at your aging AR on a monthly basis.”
Jocelyn Gaddie, in2itive, quoted in Same-Day Surgery
Many centers miss these targets. HST Pathways found that about 30% of A/R across the surgery centers it sampled was more than 90 days old.
Payer mix, out-of-network volume and implant-heavy cases all shift these numbers. Set targets by payer type, track personal injury and litigation cases separately, and use our list of ASC RCM performance metrics for the rest of the dashboard.
Step 1: Clean the A/R Before Working It
An inflated aging report sends staff after claims that are already settled. Start by confirming that every payment received has been posted and that missing contractual adjustments are applied, which accurate payment posting handles at the source.
Next, resolve overpayments and remove duplicate charges. Unworked credit balances distort the report and carry refund obligations of their own. This cleanup often shrinks the over-90 bucket and shows the true amount still at risk.
Step 2: Sort Aged Claims by Why They Are Unpaid
An aging report shows how old a claim is, not why it is unpaid. Pull every claim over 60 days and place it in one of five groups, because each group needs a different fix.
1. No Response on File
The payer has no record of the claim, or it is stuck in processing. Confirm receipt and keep the clearinghouse acceptance report as proof of timely filing.
2. Denied Without an Appeal
A denial was posted but never corrected or appealed. While the appeal window is open, these are often the fastest wins, and a steady ASC denial management routine stops them from piling up.
3. Pending Records or Implant Invoices
High-dollar cases often stall while the payer waits for operative notes or implant invoices. Send the full packet in one go, with the claim number on every page, and check the contract’s implant carve-out terms first.
4. Paid Below the Contract Rate
A partial payment can make a claim look closed when it isn’t. Compare the allowed amount with your payer contract and flag short payments for an underpayment appeal.
5. Balances Not Moved On
Once the primary payer pays, the remaining balance must go to the secondary plan or the patient. Balances left in this state age without anyone working them.
Step 3: Map Every Claim’s Recovery Deadline
Age alone does not make a claim uncollectible. A missed deadline does. These five limits decide how much aged ASC A/R can still be recovered.
1. Medicare Timely Filing
Medicare claims generally must be filed within 12 months of the date of service under 42 CFR 424.44. A claim the contractor never received is lost once that year passes.
2. Commercial Filing Limits
Commercial plans set their own limits in the contract, often 90 to 180 days. Keep a payer-by-payer list, because one short limit can erase a whole month of cases.
3. Appeal Windows
Medicare allows 120 days from the initial determination to request a redetermination. Commercial appeal windows vary by plan, so log the date on every denial.
4. Corrected Claim Limits
Some payers accept corrected claims only within a set period after the original payment. After that, the fix has to go through an appeal or a reopening request.
5. Proof of Timely Filing
When a payer says a claim arrived late, clearinghouse acceptance reports and payer acknowledgments are your evidence. Store them with each claim. Our post on timely filing denials covers these disputes in detail.
Step 4: Rank Claims by Value and Urgency
Business office time is limited, so rank claims before chasing them. Dollar value and days left before the deadline set the order.
| Priority | Claims in this group | First action | Target |
|---|---|---|---|
| Tier 1 | High-dollar cases with a deadline inside 30 days | Appeal, correct or resubmit now | This week |
| Tier 2 | High-dollar cases with no payer response | Call the payer, confirm receipt, send records | Within 2 weeks |
| Tier 3 | Mid-value claims sharing one denial reason | Fix in a batch and request a group review | Within 30 days |
| Tier 4 | Low balances past every deadline | Document the reason and approve the write-off | Monthly review |
Re-rank the list every week. A Tier 2 claim moves to Tier 1 as its deadline gets closer, and a paid claim drops off.
Check that the team can actually clear the list. A collector who works about 40 accounts a day covers roughly 800 a month, so a backlog of a few thousand open accounts may need more hands than the business office has.
Step 5: Work Each Claim to Resolution
With claims cleaned, sorted, dated and ranked, each one follows the same path:
- Confirm the status. Check the payer portal or call, and record the exact reason the claim is unpaid.
- Match the fix to the reason. Resubmit with proof of timely filing if the payer never received the claim, send a corrected claim for coding or data errors, file an appeal with the operative note for a denial, or send the full records packet for a pending request.
- Set the next touch date. Schedule follow-up 14 to 21 days out before closing the account, and log every call and reference number.
- Route short payments separately. Underpaid claims go through an underpayment appeal backed by the contract rate.
A claim over 150 days old that keeps bouncing back usually has a deeper problem, such as the wrong payer, the wrong claim form or a credentialing gap. Fix that root cause before sending it again.
Step 6: Escalate Claims That Stall
When a claim stays stuck after repeated calls, move it up the chain instead of logging another call note. Escalate in this order:
- Provider representative. Send your assigned payer contact a list of stalled high-dollar claims.
- Group review. When many claims share one issue, ask the payer to review them together rather than one by one.
- Contract dispute terms. Use the dispute steps in your payer contract for repeated underpayments or delays.
- Prompt-pay complaint. Most states set payment deadlines for clean claims, and your state insurance department accepts complaints when payers miss them. Arbitration is the final option for large disputed balances.
Step 7: Resolve Patient Balances Before They Stall
Patient responsibility ages quickly once insurance has settled. Send clear patient statements as soon as the secondary payer adjudicates, offer payment plans for larger balances, and screen for financial assistance where your policy allows it.
Set written rules for when a patient account moves to a collection agency, and apply them the same way every time. Propensity-to-pay scores help decide which accounts need a call and which need a plan, while collecting estimated copays before surgery keeps most of these balances from forming.
When an Aged Claim Should Be Written Off
A claim reaches write-off only when every filing and appeal deadline has passed, or when recovery would cost more than the balance. Even then, post it with a reason-specific adjustment code, such as timely filing, appeal exhausted, small balance or bad debt, and require manager approval above a set dollar amount.
Review write-offs by reason every month. A rising timely filing write-off points to slow submission or follow-up, and our guide to healthcare bad debt covers the patient side of these losses.
Track collections on cases over 90 days as well. As Surgical Notes explains in Becker’s, a falling share of collections from older cases is an early sign that aged A/R is being ignored.
Stopping New Surgery Center Claims From Aging
Recovery only lasts if fewer claims age to begin with. The Becker’s review recommends following up on every claim within 21 days of submission, sending implant invoices as soon as they are available, and appealing low or incorrect payments within 48 hours.
Speed at the start of the cycle matters just as much. Get operative notes dictated promptly, send claims within a day or two of the case on the correct ASC claim form, and touch every unpaid claim at least every 28 days until it resolves.
Our list of ASC billing fixes for net collections covers the charge capture and KPI tracking that support this.
Find out what your 90-day claims are still worth
Share your aging report and the MBW RCM A/R team will rank every open claim by value and deadline, then show you which ones can still be paid.
Signs Your Business Office Needs Recovery Help
A/R recovery needs steady follow-up time, and a lean business office rarely has it while handling daily charges and patients. Outside help makes sense in three situations:
- A/R over 90 days stays above 20% of total A/R.
- Claims pass filing limits before anyone touches them.
- One payer’s balance keeps growing month after month.
A dedicated A/R follow-up team can clear the aged backlog while your staff keeps new claims current. That team should know facility claim rules, implant contracts and payer appeal steps.
If you are weighing the staffing side of that decision, our comparison of in-house vs outsourced ASC billing breaks down cost and control.
Protecting Surgery Center Cash From Avoidable Write-Offs
Most aged surgery center claims are still recoverable. The ones that get written off are usually claims nobody sorted, dated or ranked in time. Clean the A/R first, work claims in deadline order, escalate the ones that stall, and write off only with a documented reason that points back to the step that failed.
Surgery centers that run this process every week keep cash flowing for staff, equipment and new cases. Through its ASC billing services, MBW RCM pairs aged-claim recovery with front-end prevention, so balances stop drifting back past 90 days.