Cardiology
Modifier 26/TC professional-vs-technical splits and stress-test medical-necessity denials that stack and age past 90 days (CPT 2026; flagged for Coding Director verification).
cardiology AR recovery →Aged AR recovered · 50+ specialties · all 50 states
Accounts Receivable Recovery Services for U.S. Healthcare Providers
Yes, unpaid medical bills can be referred to collections — typically after 90 to 180 days of non-payment. RevalonMD's accounts receivable recovery service intervenes before claims reach that threshold: our AAPC- and AHIMA-certified revenue cycle team recovers aged payer and patient balances through structured follow-up, achieving a 99% first-pass claim rate that prevents most AR from aging past 30 days.
99% first-pass figure is a RevalonMD target — 99% first-pass claim rate is a RevalonMD operating target; individual practice results vary by specialty, payer mix, and documentation quality.
Free consult
Get a free AR recovery consultation
We review your AR aging report, identify your recoverable balances by payer and bucket, and return a written recovery roadmap. Practice profile only — no PHI required to book.
Definition
What is accounts receivable recovery in medical billing?
Accounts receivable recovery is the structured process of collecting outstanding payments from payers and patients for services already delivered. It spans AR aging analysis, payer follow-up, denial appeals, patient balance outreach, small-balance recovery, and credit balance resolution — converting aged receivables into cash before they age past the timely-filing window or write-off threshold.
That definition matters because every unpaid claim is revenue your practice has already earned — the care was delivered, the cost was incurred, and the only thing missing is the payment. Accounts receivable recovery converts that earned-but-unpaid revenue back into cash before it ages past the point of collectibility.
Recovery work spans both sides of the ledger. On the payer side, it means AR aging analysis, payer follow-up, and denial appeals on commercial and government claims. On the patient side, it means structured balance outreach, payment plans, and small-balance recovery — followed by credit balance resolution when a payer or patient has overpaid. RevalonMD runs all six functions inside your existing system.
Accounts receivable recovery is one stage of a larger cycle. It is the downstream recovery function within end-to-end revenue cycle management — and the most cost-effective recovery is the claim that is paid cleanly on first submission, which is why medical billing accuracy is the first line of AR prevention.
RevalonMD integrates with any EHR or practice management system — no proprietary platform lock-in. We work your AR inside RCM AR worklists, Waystar, payer portals, patient payment platforms, and dialer or outreach tools you already use.
Primary question
Can medical bills go to collections?
Yes. Unpaid medical bills can be referred to a collection agency — typically after 90 to 180 days of non-payment. For insurance claims, timely-filing windows range from 90 to 365 days by payer; Medicare allows one calendar year from the date of service. RevalonMD's AR recovery service follows up on aging claims before they reach the collections threshold.
The collections threshold is a moving target set by each payer’s timely-filing window and each practice’s patient-balance policy. The table below shows why the calendar — not the balance — usually decides whether a claim is recovered or written off, and where in the aging curve RevalonMD intervenes.
The financial stakes
The AR aging problem: why aged claims cost more than they think
Aged claims cost more because recovery probability decays sharply with time. Claims worked inside 30 days recover at over 90%; by 90 days, recovery falls to roughly 50 to 60%, and past 120 days it drops below 50% (Resolve, 2025). HFMA benchmarks set a target of fewer than 15% of total AR in the 90-plus day bucket.
The numbers below set the benchmark against which AR recovery performance is measured. Each aging bucket carries a different recovery probability — which is why prioritizing the oldest, highest-value, timely-filing-risk claims first is the structural foundation of effective recovery.
>90%
Recovery rate on claims worked within 30 days
Resolve, AR Aging Past 90 Days Write-Off Statistics, 2025
<50%
Recovery rate once a claim passes 120 days
Resolve, 2025 — most payer types
<15%
Target share of total AR in the 90+ day bucket
HFMA, Best Practices for Resolution of Medical Accounts, 2022
<40
Target days in AR for high-performing practices
MGMA, Days in AR Benchmark, 2025
| AR aging bucket | Typical recovery rate | Stage | What is happening |
|---|---|---|---|
| 0–30 days | >90% | Proactive billing window | Clean claims paid on first pass. The cheapest dollar to recover is the one that never ages. |
| 31–60 days | 80–90% | Standard follow-up window | Routine payer follow-up resolves most balances. Soft denials and pended claims surface here. |
| 61–90 days | 70–80% | Escalation needed | Claims require active escalation through payer provider-relations channels and appeal preparation. |
| 90–120 days | 50–60% | Urgent — timely-filing risk | Many payers' timely-filing windows close in this range. Recovery probability falls sharply (Resolve, 2025). |
| 120+ days | <50% | Write-off risk | Specialist intervention required. Past 120 days, most payer types recover below 50% (Resolve, 2025). |
Sources: Resolve, “AR Aging Past 90 Days Write-Off Statistics,” 2025 (recovery-rate decay); HFMA, “Best Practices for Resolution of Medical Accounts,” 2022 (<15% of total AR in 90+ days; net collection rate ≥95% of allowables); MGMA, Days in AR Benchmark, 2025 (days in AR <40). Recovery rates are representative industry ranges, not guarantees.
Process
RevalonMD’s 6-step AR recovery process
RevalonMD recovers aged receivables through a six-step process: (1) AR aging segmentation by bucket and payer, (2) payer-priority queue assignment, (3) insurance follow-up and appeals, (4) denial resolution by CARC/RARC code, (5) patient balance outreach with payment plans, and (6) credit balance resolution with dashboard reporting on cash recovered and days in AR.
The sequence is deliberate: segment first, prioritize by deadline and dollar value, then work payer and patient balances through to resolution and reporting. Every step runs inside your existing EHR, executed by AAPC- and AHIMA-certified staff.
- Step 1: AR Aging SegmentationGenerate and segment the AR aging report by bucket (0–30, 31–60, 61–90, 90–120, 120+ days) and payer type. Prioritize claims by value and timely-filing proximity, so the dollars closest to expiring are worked first.
- Step 2: Payer-Priority Queue AssignmentAssign claims to payer-specific follow-up queues. High-value and timely-filing-risk claims are escalated to the front of the queue, where a payer's deadline determines urgency rather than the date of service.
- Step 3: Insurance Follow-Up & AppealsSubmit corrections, appeal denied claims with supporting documentation, and escalate through payer provider-relations contacts. Payer follow-up is the core recovery activity for aged commercial and government balances.
- Step 4: Denial ResolutionIdentify the CARC and RARC codes driving each denial, prepare the appeal with clinical or administrative justification, and resubmit within the payer's appeal window. Coding-layer denials route to the Coding Director.
- Step 5: Patient Balance OutreachFor patient-responsibility balances, initiate the statement and dunning cycle and offer payment plans. Self-pay collections follow FDCPA-adjacent best practices and applicable state medical-debt rules.
- Step 6: Credit Balance Resolution & ReportingResolve credit balances and process refunds and adjustments. Deliver a recovery dashboard reporting cash recovered, the days-in-AR delta, and the net collection rate so the practice can verify the engagement's impact.
Step 6 closes the loop with a dashboard you can verify.
Recovery work is only credible when its impact is measurable. RevalonMD delivers a recovery dashboard at the reporting stage — cash recovered, the days-in-AR delta, and the net collection rate — so a practice administrator can confirm the engagement moved the metrics that matter, not just the activity count.
Specialty proof
AR recovery for 50+ medical specialties
AR ages differently by specialty because each discipline’s procedure mix, modifier patterns, and payer medical-necessity policies concentrate denials in different buckets. RevalonMD maintains specialty-specific AR recovery workflows for every specialty we serve — the examples below show the recurring drivers that strand revenue in the 61-to-120-day range.
Gastroenterology
Screening-vs-diagnostic colonoscopy classification, Modifier 33/PT disputes, and bundling denials that delay payment on otherwise clean claims (CPT 2026; flagged for Coding Director verification).
gastroenterology AR recovery →ENT
Bundled endoscopy claims, Modifier 50 bilateral pricing, and allergy-unit denials that require payer-specific appeal documentation (CPT 2026; flagged for Coding Director verification).
ENT accounts receivable recovery →Emergency Medicine
E/M leveling disputes, critical-care time documentation gaps, and facility-vs-professional-fee splits that fragment a single encounter across payer queues.
emergency medicine AR recovery →Dermatology
Cosmetic-vs-medical-necessity determinations and lesion-documentation unit counts that trigger medical-necessity denials aging in the 61–90 day bucket.
dermatology AR recovery →Anesthesiology
Base-plus-time unit disputes, QY/QX/QZ modifier challenges, and medical-direction denials that require precise documentation to recover.
anesthesiology AR recovery →Compliance
Is it illegal to send medical bills to collections?
Sending medical bills to collections is not inherently illegal. The Fair Debt Collection Practices Act (FDCPA, 15 U.S.C. § 1692) governs third-party debt collectors, not original healthcare providers billing their own patients. However, providers must comply with the No Surprises Act for out-of-network claims and applicable state medical debt laws before initiating collections.
Three regulatory layers govern provider AR and collections, and they are frequently confused. The breakdown below separates what the FDCPA actually covers, what the No Surprises Act requires for out-of-network claims, and the current — and recently changed — status of medical debt on credit reports.
FDCPA (15 U.S.C. § 1692)
Applies to third-party debt collectors only. Healthcare providers billing their own patients are original creditors and are not directly covered; a third-party collection agency engaged by the provider is subject to the FDCPA.
No Surprises Act (45 CFR parts 149, 800)
For out-of-network billing, a Good Faith Estimate is required for uninsured and self-pay patients, the Qualified Payment Amount (QPA) must be verified, and the Independent Dispute Resolution (IDR) process must be exhausted before pursuing collections on NSA-covered claims (effective January 1, 2022).
CFPB Regulation V
Finalized January 7, 2025, the rule would have prohibited medical debt on credit reports, but a federal court (E.D. Texas) vacated it on July 11, 2025. As a result, medical debt can still appear on credit reports as of mid-2026, subject to state law.
State medical-debt laws
Nine or more states maintain independent medical-debt credit-reporting bans as of January 2026. Applicable state rules must be checked before initiating patient collections in each jurisdiction.
Upstream prevention
How RevalonMD protects your revenue before claims age
RevalonMD prevents most AR from aging by getting claims paid on first submission. Our AAPC- and AHIMA-certified team targets a 99% first-pass claim rate (a RevalonMD operating target), so fewer claims enter the 31-to-90-day buckets where recovery probability begins to fall. Clean front-end submission is the most cost-effective form of AR recovery.
Recovery and prevention are two ends of the same lever. The metrics below are the targets RevalonMD operates against — clean front-end submission keeps claims out of the aging report, and structured recovery brings back the balances that still slip through.
| Metric | RevalonMD | Industry benchmark | Source |
|---|---|---|---|
| First-pass claim rate | 99% (target) † | 85–90% avg | RevalonMD |
| Days in AR target | <40 days | <40 days | MGMA, 2025 |
| Net collection rate | ≥95% of allowables | ≥95% target | HFMA, 2022 |
| AR in 90+ day bucket | <15% of total AR | <15% | HFMA, 2022 |
| Starting billing rate | 2.99% of collections (target) † | 4–8% industry avg | RevalonMD |
| BAA provided | Every client (target) † | Not standard | RevalonMD |
† First-pass claim rate (99%), starting billing rate (2.99% of collections), and a signed BAA with every client are RevalonMD operating targets — 99% first-pass claim rate is a RevalonMD operating target; individual practice results vary by specialty, payer mix, and documentation quality. 2.99% is a starting-rate target; final rate depends on specialty, volume, and services included.
How it works in practice
A worked AR recovery engagement
Industry benchmarks describe the average; an actual workflow shows the mechanism. The representative engagement below reflects the aged-AR pattern RevalonMD sees most often in multi-specialty group practices.
Payer scope
Every payer type, every aging bucket
RevalonMD recovers balances from every major payer category. Each carries its own timely-filing window and follow-up pathway, so the recovery clock is tracked per payer — not per practice.
Medicare
Part A and Part B. Timely filing: one calendar year from the date of service (CMS).
Medicaid
State-specific timely filing (typically 90–180 days); coverage across all 50 state programs.
Commercial payers
All major commercial payers; timely-filing windows vary by contract (90–365 days).
Self-pay / Patient
Patient balance outreach, payment plans, and a compliant statement and dunning cycle.
DME payers
DME-specific claim requirements with HCPCS Level II coding (HCPCS 2026; flagged for Coding Director verification).
Out-of-network (OON)
No Surprises Act compliant — QPA verification and the IDR process before collections where required.
Medicare timely filing: one calendar year from the date of service (CMS Medicare Claims Processing Manual). HCPCS Level II references use HCPCS 2026 and are flagged for Coding Director verification. Out-of-network recovery follows No Surprises Act requirements (45 CFR parts 149, 800).
Nationwide
AR recovery across all 50 states
RevalonMD recovers accounts receivable for healthcare providers in all 50 states, across 50-plus medical specialties. State-specific timely-filing windows, Medicaid rules, and medical-debt credit-reporting laws differ, so our team tracks the applicable deadlines and compliance requirements for each payer and jurisdiction in your practice's footprint.
State variation is real and consequential. Medicaid timely-filing windows, patient collections rules, and medical-debt credit-reporting bans (9+ states as of January 2026) differ by jurisdiction. RevalonMD tracks the applicable deadlines and compliance requirements for each state in your practice’s footprint, so a multi-location or multi-state group is governed by one coordinated recovery team rather than fifty separate playbooks.
Talk to a specialist
Talk to an AR recovery specialist
RevalonMD recovers aged payer and patient balances through AR aging analysis, payer follow-up, denial appeals, and patient outreach for practices across 50+ specialties in all 50 states — using AAPC- and AHIMA-certified staff and a signed BAA before any PHI is accessed. We pursue every viable dollar — no hidden fees, no long-term contracts.
Starting billing rate: 2.99% of collections (target, pending founder sign-off) · BAA signed with every client before any PHI access (target).
Phone: (307) 333-8199
Email: support@revalonmd.com
Hours: Mon–Fri 8am–6pm EST · Sat 9am–1pm EST
Free consult
Get a free AR recovery consultation
Practice profile + contact info only — no PHI required to book.
Trust signals
Credentialed, compliant, nationwide
AAPC-certified coders
Certified Professional Coders (CPC)
AHIMA-certified coders
RHIA · CCS credentialed
Signed BAA with every client
Executed before any PHI access (target)
HIPAA-compliant workflow
45 CFR §§164.502, 164.504 — Privacy + Security Rules
All 50 states
State timely-filing and medical-debt rules tracked
50+ medical specialties
Specialty-specific AR recovery workflows
Reviewed by RevalonMD Leadership & Editorial Review · Last reviewed: June 2026
FAQ
Frequently asked questions about AR recovery
Yes. Unpaid medical bills can be referred to a collection agency — typically after 90–180 days. RevalonMD's AR recovery service reduces this risk by following up on aging claims before they reach the collections threshold.
No. The FDCPA governs third-party debt collectors, not original providers. Providers must comply with the No Surprises Act for out-of-network claims and applicable state medical debt laws before initiating collections. (Source: FDCPA, 15 U.S.C. § 1692; No Surprises Act, 45 CFR parts 149, 800)
Most providers refer unpaid balances to collections after 90–180 days. For insurance claims, timely-filing windows range from 90 to 365 days by payer. Medicare's timely filing deadline is one calendar year from the date of service. (Source: CMS Medicare Claims Processing Manual)
AR recovery is the structured process of collecting outstanding payments from payers and patients for services already delivered — including AR aging analysis, payer follow-up, denial appeals, patient outreach, and small-balance resolution to convert aged receivables to cash.
As of mid-2026, medical debt can still appear on credit reports. The CFPB's January 2025 rule barring medical debt from credit reports was vacated by a federal court in July 2025. Nine or more states have independent medical debt credit reporting bans. (Source: CFPB, Regulation V, 2025; vacated E.D. Texas, July 11, 2025)
HFMA benchmarks define high-performing practices as those with fewer than 15% of total AR in the 90+ day aging bucket. MGMA benchmarks set days in AR under 40. A net collection rate of 95%+ of allowables is the industry target. (Sources: HFMA, 2022; MGMA, 2025)
RevalonMD follows a 6-step process: AR aging segmentation, payer-priority queue assignment, insurance follow-up with documentation, denial appeal submission, patient balance outreach, and credit balance resolution — with reporting dashboards at each stage.
Initial recoveries from the 31–90 day bucket typically produce cash within 30–60 days of engagement. Aged claims in the 90–120+ day bucket may require 60–120 days for full resolution, depending on payer responsiveness and claim complexity.
Who stands behind this page
Methodology: AR aging benchmarks on this page cite HFMA (“Best Practices for Resolution of Medical Accounts,” 2022) for the <15%-of-AR-in-90+-days and ≥95% net-collection-rate targets, and MGMA (Days in AR Benchmark, 2025) for the days-in-AR target. The recovery-rate decay model cites Resolve (“AR Aging Past 90 Days Write-Off Statistics,” 2025). Regulatory claims cite the FDCPA (15 U.S.C. § 1692), the No Surprises Act (45 CFR parts 149, 800, 2022), CFPB Regulation V (finalized January 7, 2025; vacated by E.D. Texas, July 11, 2025), and the HIPAA Privacy and Security Rules (45 CFR §§164.502, 164.504). Any CPT/ICD-10-CM/HCPCS reference names its code year (CPT 2026, AMA; ICD-10-CM 2026, CMS/NCHS; HCPCS 2026, CMS) and is verified by the RevalonMD Coding Director before publication. Performance figures (99% first-pass, 2.99% starting rate, BAA with every client) are RevalonMD operating targets — not industry averages presented as guarantees. The worked operator example is anonymized and contains no PHI. Regulatory status is re-verified at the 6-month WARM refresh.
HFMA — Resolution of Medical Accounts (2022)MGMA — Days in AR Benchmark (2025)Resolve — AR Aging Write-Off Stats (2025)FDCPA — 15 U.S.C. § 1692No Surprises Act — 45 CFR parts 149, 800CFPB — Regulation V (2025, vacated Jul 2025)45 CFR §§164.502, 164.504CMS — Medicare Claims Processing ManualAMS Solutions — RCM Best Practices 2026CPT 2026 (AMA)ICD-10-CM 2026 (CMS/NCHS)HCPCS 2026 (CMS)
Stop writing off aged claims. Recover the revenue you have already earned.
Free AR recovery consultation · aging-bucket breakdown of your recoverable balances · written recovery roadmap. Practice profile only — no PHI required to book.