Don’t Let Them Age Out: A Guide to Timely Underpayment Appeals
In medical billing, every day counts. You’ve provided quality patient care and submitted a clean claim, only to discover you’ve been underpaid. It’s frustrating—and it’s tempting to push the issue down your to-do list. But here’s the truth: underpaid claims have an expiration date.
Just like initial claims, underpayment appeals must be submitted within the payer’s timely filing limit. Depending on the payer and claim type, that could be as short as 90 days or as long as 180 days or more. Miss the deadline, and you may lose the right to appeal entirely, turning what could have been a correctable underpayment into permanent lost revenue.
Table of Contents
1. Understanding Timely Filing Limits
Each payer has its own rules for timely filing. These rules apply not only to original claims but also to resubmissions, corrected claims, and appeals.
Typical timelines range from 90–180 days.
Some commercial payers may extend the window, while government payers often have stricter rules.
Filing windows can reset based on the Explanation of Benefits (EOB) date, not just the date of service—so knowing the fine print matters.
The key is clarity: your staff must know exactly what the rules are for each payer, and you need systems in place to ensure nothing slips through.
2. The Financial Consequences of Missed Deadlines
Missing a timely filing deadline has both immediate and long-term impacts:
Lost Revenue: If a $50 underpayment misses the appeal window, it’s gone forever. Multiply that across hundreds of claims, and practices may lose thousands or even millions annually.
Increased Administrative Costs: Billing staff still invest time in identifying discrepancies, but with no recovery, it’s wasted effort. This increases overhead without return, hurting both your bottom line and staff morale.
Compounding Issues: Aging claims can create confusion, especially if patients are mistakenly billed for the unpaid amount. This damages patient trust and can harm your reputation.
3. Common Reasons Appeals “Age Out”
Why do practices let valid appeals slip away?
No tracking system: Without a centralized log, deadlines vanish.
Overloaded staff: Underpayments get de-prioritized compared to new claims.
Rule confusion: Different payers = different windows = frequent errors.
Documentation delays: Waiting for records or provider input eats into filing time.
Each of these challenges can be solved with the right processes and technology. Practical strategies on preventing underpayment in medical billing show how proactive management reduces these risks.
4. Best Practices for Fast, Efficient Appeals
To avoid aging out, you need proactive and systematic processes:
Identify Underpayments Immediately: Compare payments to your fee schedule the moment they’re posted. Automating this through RCM software flags discrepancies in real time gives practices a faster way to respond. Deciding whether to rely on staff or technology is a key step, and our guide on automation vs manual review in underpayment recovery explains how to choose the right approach.
Prioritize High-Value Claims: Recover large underpayments first while still tracking smaller ones.
Create Standardized Appeal Packets: Include the original claim, EOB/ERA, a clear appeal letter citing contract terms, and supporting documentation (medical records, payer contract excerpt).
Centralized Tracking: Maintain a real-time log of appeals, noting deadlines, submission dates, and expected responses.
Set Internal Deadlines: Aim to appeal within 30 days, regardless of the payer’s limit.
Use Templates and Checklists: Standardized forms save valuable time when the clock is ticking.
5. Building a Sustainable Appeal Workflow
An efficient appeal workflow makes timely filing second nature:
Immediate EOB review upon posting.
Assign responsibility for each underpayment to a designated staff member.
Generate appeal packet quickly using templates and checklists.
Submit early to avoid deadline pressure.
Track responses and follow up automatically.
With a repeatable workflow, appeals become a routine part of your revenue cycle instead of a last-minute scramble.
6. Proactive Strategies to Minimize Appeals
Preventing underpayments reduces the number of appeals you’ll ever need to file:
Regular payer audits to spot recurring errors.
Front-end accuracy in coding, modifiers, and eligibility verification.
Maintain payer playbooks with up-to-date filing deadlines and rules.
Fewer underpayments = fewer appeals = less risk of missing filing windows.
If you are interested to read more about underpayment in specialty-specific practical insights, please have a look at this case study: ‘‘$200K Recovered: A Radiology Underpayment’’.
Conclusion: Your Revenue, Your Responsibility
Recovering underpayments isn’t just about collecting what’s owed—it’s about protecting the financial health of your practice. Timely filing is non-negotiable. Even the strongest appeal won’t succeed if it’s late. By identifying underpayments quickly, creating standardized appeal processes, and implementing tracking systems, you can ensure that no claim ages out unnecessarily.
Is your practice losing money to aging underpayments? Don’t wait until deadlines pass.
Contact MBW RCM today for a comprehensive review of your billing, underpayment recovery and appeals process. We’ll help you recover what you’re owed and implement strategies to ensure no revenue ever gets “aged out” again.
