Breaking a $1.2M Surgical Claims Backlog: How an ENT Practice Accelerated Cash Collections
A multi-location ENT practice in Pennsylvania was experiencing slower cash collections despite stable surgical volumes. Aging surgical accounts delayed reimbursements and impacted cash flow.
Our assessment found that inconsistent payer follow-up, unresolved appeals, underpaid surgical claims, and poor prioritization of high-value accounts were extending collection timelines across Medicare and commercial payers.
After implementing a specialty-focused Accounts Receivable Follow-Up strategy, we recovered more than $1.2 million in outstanding receivables, reduced A/R over 90 days by 34%, shortened collection cycles by 21 days, and improved monthly cash collections.
Client Overview
Location: Pennsylvania, USA
Specialty: ENT (Otolaryngology)
Providers: 9 Otolaryngologists
Practice Type: Multi-Location Physician Group
Monthly Claims Submitted: ~3,450
Outstanding A/R Reviewed: $4.8 Million
Assessment Period: 120 Days
Key CPT Codes Reviewed
30520 – Septoplasty
31256 – Endoscopic Maxillary Antrostomy
42826 – Tonsillectomy
69436 – Tympanostomy Tube Placement
31575 – Flexible Laryngoscopy
30140 – Inferior Turbinate Reduction
What Was Happening
Although claims were submitted on time, reimbursement slowed because aging surgical accounts were not consistently followed after payer adjudication. More than $1.2 million in receivables remained outstanding, with many high-value ENT procedures exceeding 90 days in A/R.
Our review found that billing staff focused primarily on newly denied claims while partially paid claims, unresolved appeals, and underpayments received inconsistent follow-up. As surgical volumes increased, the backlog continued to grow, delaying collections and increasing the risk of write-offs.
Key Assessment Findings
We conducted a 120-day review of the practice's accounts receivable operations, analyzing aging reports, payer correspondence, remittance activity, appeal status, and collector workflows.
High-Value Surgical Claims Were Not Prioritized
Large-dollar surgical claims were worked alongside lower-value office visits, delaying recovery of significant outstanding balances.
Payer Follow-Up Was Inconsistent
Follow-up schedules varied among collectors, resulting in delayed status checks and inconsistent payer escalation.
Appeals Remained Unresolved
Denied surgical claims requiring operative reports and medical necessity documentation often remained pending beyond payer review timelines.
Underpayments Went Unidentified
Payments were posted without consistently validating contracted reimbursement amounts, allowing surgical underpayments to remain unrecovered.
Aging Accounts Lacked Strategic Prioritization
Accounts were worked by age rather than financial value, limiting recovery of high-value surgical receivables.
Our Strategic Approach
We implemented a targeted Accounts Receivable Follow-Up strategy to recover outstanding surgical claims, improve payer accountability, and accelerate cash collections.
➤ High-Value Surgical Claim Prioritization
Outstanding surgical claims were prioritized by reimbursement value, payer, and aging bucket, ensuring high-dollar procedures received immediate follow-up.
➤ Standardized Payer Follow-Up
Payer-specific follow-up schedules and escalation workflows were implemented for Medicare and commercial insurers to improve consistency and reduce collection delays.
➤ Structured Surgical Appeal Management
Denied surgical claims were supported with operative reports, medical necessity documentation, and payer-specific records to improve appeal resolution.
➤ Contracted Payment Validation
Surgical reimbursements were reconciled against contracted payer rates to identify underpayments and recover missed revenue.
➤ Intelligent A/R Work Queue Management
Work queues were organized by claim age, outstanding balance, payer status, and next-action dates, improving follow-up on aging surgical accounts and reducing outstanding receivables.
Results We Achieved
Following implementation of the new Accounts Receivable Follow-Up strategy during the 120-day assessment period, the practice significantly improved collection performance and reduced its backlog of aging surgical claims.
Key Outcomes
Recovered more than $1.2 million in outstanding surgical receivables
Reduced the 90+ day A/R balance by 34%
Shortened the average collection cycle by 21 days
Increased monthly cash collections by 19%
Improved surgical appeal resolution across Medicare and commercial payers
Recovered underpaid surgical reimbursements through contracted payment validation
Performance Metrics
| Metric | Before MBW RCM | After MBW RCM |
|---|---|---|
| Outstanding Surgical A/R | $1.2M Backlog | Recovered & Actively Managed |
| 90+ Day A/R Balance | 31% | 21% |
| Average Collection Cycle | 68 Days | 47 Days |
| Monthly Cash Collections | Baseline | +19% |
| High-Value Claim Prioritization | Manual | Value-Based Workflow |
Effective follow-up on aging surgical claims is essential for improving cash flow and reducing outstanding receivables. By strengthening payer follow-up, streamlining appeals, and validating reimbursements, the practice significantly improved collection performance with specialized Accounts Receivable Services.
With dedicated ENT Billing Services, the practice established a more efficient revenue cycle, accelerating collections while supporting long-term financial performance.
Still Waiting on Outstanding ENT Claims?
Outstanding receivables and inconsistent payer follow-up can delay the revenue your practice has earned. Fill out the form below, and our specialists will assess your A/R workflow, identify collection opportunities, and help improve cash flow. We'll get in touch with you shortly.
