For many hospitals, one of the most overlooked opportunities to improve financial performance is already sitting inside the revenue cycle: aging accounts receivable.
Over time, even well-run revenue cycle operations accumulate backlogs of unresolved claims and outstanding balances. Complex payer rules, claim denials, staffing shortages, and competing priorities can push certain accounts to the back of the work queue.
When this happens, accounts age beyond the standard collection window—and the likelihood of recovering payment begins to decline.
For healthcare finance leaders under increasing pressure to improve cash flow and reduce days in A/R, addressing these aging accounts requires a focused and strategic A/R workdown approach.
Accounts receivable represents the payments owed to healthcare organizations for services that have already been delivered but not yet reimbursed by payers or patients.
When claims remain unresolved for extended periods of time, they move into aging categories—typically measured in 30-day intervals such as:
As accounts age, they become more difficult to resolve. Payers may impose filing limits, documentation requirements may become harder to satisfy, and internal staff may have less visibility into the original claim details.
Without a structured approach to follow-up, these aging accounts can quickly turn into lost revenue.
Even organizations with strong revenue cycle processes can experience A/R backlogs.
Several common operational factors contribute to the problem.
Every payer has unique policies, timelines, and documentation requirements. When claims are denied or underpaid, revenue cycle teams must investigate the issue, correct the claim, and resubmit it.
If denial volumes rise faster than staff capacity, unresolved claims begin to accumulate.
Revenue cycle teams must balance multiple priorities each day, including:
Because new claims represent the most immediate path to reimbursement, older accounts are often deprioritized—allowing aging A/R to grow.
Healthcare organizations across the country continue to face staffing challenges in revenue cycle operations.
Recruiting and retaining experienced billing specialists, denial analysts, and A/R follow-up staff can be difficult. When teams are understaffed, productivity declines and backlogs increase.
Major technology initiatives—such as EHR or patient accounting system conversions—can also create A/R accumulation.
During system transitions, staff must learn new workflows while continuing to manage existing claims. This disruption often slows collections and increases aging A/R.
Without dedicated resources to work legacy accounts, large balances may remain unresolved for months or even years.
Recovering aging A/R is not simply a matter of increasing call volume to payers. Effective workdown strategies require targeted prioritization and data analysis.
One of the most effective approaches is A/R stratification—segmenting accounts based on characteristics such as age, payer type, balance amount, and denial history.
This allows revenue cycle teams to focus their efforts on accounts with the highest probability of successful recovery.
Common A/R workdown strategies include:
By segmenting and prioritizing accounts, organizations can maximize recovery while using staff resources more efficiently.
While the value of A/R workdown is clear, many hospitals struggle to execute these projects internally.
Revenue cycle leaders often face a difficult trade-off:
Should staff focus on resolving legacy accounts—or prioritize current claims to prevent new backlogs?
In reality, most teams simply do not have the capacity to do both.
Working aging A/R requires:
These tasks are time-intensive and require specialized expertise.
Without dedicated resources, A/R workdown efforts often stall before meaningful progress is made.
A structured A/R workdown initiative can significantly improve financial performance by converting aging balances into collected revenue.
Benefits of a focused workdown strategy include:
Beyond the immediate financial benefit, A/R workdown projects often reveal systemic process issues that can be corrected to prevent future backlogs.
Many healthcare organizations choose to partner with external revenue cycle experts to support A/R workdown initiatives.
MEDTEAM provides specialized revenue cycle services designed to help hospitals resolve aging accounts and strengthen overall financial performance.
By serving as an extension of internal revenue cycle teams, MEDTEAM helps organizations:
MEDTEAM’s approach combines experienced revenue cycle professionals, proven workflows, and close collaboration with hospital teams to ensure transparency and measurable results.
“When we call MEDTEAM, it is great that they are always on board working to help us, whatever the need is.” - Chief Nursing Officer
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