Orthopedic AR Management: How to Resolve Outstanding Claims Before Year-End

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Orthopedic AR management at year-end works best when it starts with risk and recoverability, not the oldest balance. Identify which claims are near a filing or appeal deadline, separate denials from rejections and underpayments, fix what documentation supports, and record a final status for every account. Timing matters now. Medicare fee-for-service claims must generally be filed within 12 months of the date of service, so many claims from the last quarter of 2025 reach that limit during the last quarter of 2026 (Noridian). Below is how our billing specialists turn an aging report into a recovery plan.

Quick answer: Rank outstanding claims by deadline risk and recoverability first, then by value and age. Work the nearest deadlines, correct or appeal what is supported, and document the outcome. Some claims may not be recoverable.

Why Review Outstanding Claims Before Year-End

Unresolved AR delays cash flow, lets filing windows close, builds denial backlogs, and can distort year-end financial reports. Orthopedic practices carry extra exposure because one account may combine surgery, office visits, imaging, injections, and postoperative care, each with its own authorization, coding, and documentation rules. Cleaning up before the year closes also gives your team a clean baseline for the new one.

How to Identify and Prioritize Aging Orthopedic AR

Claim age alone does not decide what to work first. A 45-day surgical claim with a looming appeal deadline may matter more than a 100-day low-value balance. Use the table as a general workflow guide, not a universal payer deadline or reimbursement rule.

AR aging	Common claim issues	Recommended next action	Priority considerations
0–30 days	Pending claims, rejections, missing data	Confirm receipt, fix rejections, check claim status	Rejected claims may not count as filed, so fix quickly
31–60 days	Slow payer response, authorization or eligibility denials, records requests	Follow up with the payer, send requested records, start corrections	Prioritize high-value surgical claims
61–90 days	Unworked denials, underpayments, coordination-of-benefits issues	Review denial reasons, appeal or correct, compare payment to contract	Check appeal and filing windows now
Over 90 days	Repeat denials, missed follow-up, unresolved COB, possible expired deadlines	Confirm deadlines, escalate, decide to recover, appeal, or adjust per policy	Age does not equal recoverability; some may be uncollectible
Illustrative example: A practice’s 61–90 day bucket holds a knee arthroscopy denied for authorization and a group of injection claims paid below contract. Same bucket, different work: one may need a retro-authorization request or appeal, the other a contract review. This is a hypothetical example, not a client case.

Optional Claim Priority Self-Check

Score each factor 1–3 for an account, then add. This is an educational tool, not a billing, legal, or reimbursement decision. Do not enter patient names, IDs, or claim numbers.

Factor	3 points	2 points	1 point
Claim value	High	Medium	Low
Deadline	Within 30 days	31–90 days	More than 90 days away
Status	Denied or rejected, unworked	Pending, no payer response	In active payer review
Payer response	None after 30+ days	Records requested	Recent contact

10–12 points Work first

7–9 points Work next

4–6 points Routine follow-up

A near deadline should always be checked, whatever the score.

Seven Practical Steps to Resolve Outstanding Orthopedic Claims

1	Generate a complete AR aging report and verify claim-level data Pull aging by payer, date of service, and status. Confirm balances match posted ERAs. Bad data sends staff after the wrong claims.
2	Identify claims near filing or appeal deadlines Check each payer’s manual or contract. Medicare appeals have their own windows. Redeterminations generally must be requested within 120 days of receiving the initial determination.
3	Separate denials, rejections, pending claims, and underpayments Each needs different action. Never send duplicate claims to chase a pending balance.
4	Verify eligibility, authorization, referral, and COB Confirm coverage on the date of service, authorizations for surgery and advanced imaging, referrals, and the correct primary payer.
5	Review orthopedic coding and documentation Compare CPT, ICD-10-CM, modifiers, units, laterality, and operative or procedure notes with the claim. Correct only what documentation supports.
6	Submit corrected claims, appeals, and follow-ups Follow each payer’s process and deadlines, include requested records, and log dates and reference numbers.
7	Reconcile payments and document final disposition Match payments and adjustments to the ERA or EOB. Record each outcome: paid, appealed, adjusted per policy, or escalated.

Never use modifiers to get around payer edits.

Not sure which claims to work first? Our revenue cycle team can help you build a prioritized follow-up plan.

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Common Orthopedic Billing Issues That Keep Claims Unpaid

Not every denial has the same cause or appeal path. Check the payer’s policy and your contract first.

Issue	What to review	Recommended resolution
Missing or incorrect authorization	Authorization for the procedure, site, and dates	Request retro-authorization or appeal if the payer allows
Coding or modifier errors	CPT, laterality, units, and modifiers against documentation	Submit a corrected claim with supported changes
Incomplete operative or medical necessity documentation	Operative report, imaging, exam notes, conservative care history	Send records with the appeal
Eligibility and COB problems	Coverage on date of service, primary payer	Update coverage and bill the correct payer
Rejections for missing or invalid data	Clearinghouse and payer rejection reports	Correct and resubmit; rejected claims may not count as filed
Underpayments and wrong adjustments	ERA or EOB against the contracted rate	Dispute with contract support
Missed follow-up or filing deadlines	Payer limits and exception rules	Escalate and confirm whether an exception applies
Global-period or postoperative conflicts	Whether services fall within the surgical global period	Verify rules; use modifiers such as 24, 25, 57, 58, 78, or 79 only when documentation supports them

For global-period rules, see the CMS Medicare Learning Network.

Your Orthopedic Year-End AR Cleanup Checklist

☐  Export the latest AR aging report	☐  Identify high-value outstanding claims
☐  Flag approaching timely filing and appeal deadlines	☐  Review claims aged over 90 days
☐  Separate rejections from payer denials	☐  Check authorization and eligibility issues
☐  Verify coding and documentation where indicated	☐  Submit appropriate corrections and appeals
☐  Follow up on unresolved payer inquiries	☐  Reconcile payments, adjustments, and balances
☐  Document final claim status and next steps

Completed: ___ of 11. Mark each item as your team finishes it.

A 30-Day Plan to Improve Orthopedic AR Before Year-End

Stage	Focus	Key actions
Days 1–7	Audit AR and identify priority claims	Export aging, verify data, flag deadlines, rank by risk
Days 8–14	Urgent deadlines, rejections, documentation gaps	Fix rejections, request records, confirm authorizations
Days 15–21	Denials, appeals, underpayments	Submit corrections and appeals, dispute underpayments, follow up on pending claims
Days 22–30	Reconcile, escalate, monitor	Reconcile outcomes, escalate unresolved accounts, set ongoing weekly AR review

This is a planning framework, not a guarantee that payers will adjudicate or pay claims within 30 days.

When Should an Orthopedic Practice Consider Outside Billing Support?

Warning signs include persistent aged AR, a growing denial backlog, inconsistent payer follow-up, limited staffing, weak reporting visibility, and the same preventable errors repeating. At MedCloudMD, we combine technology-supported workflows with experienced billing specialists to support claim tracking, denial follow-up, AR prioritization, and reporting. We cannot promise recovery of every balance, but a structured review shows what is recoverable.

Frequently Asked Questions About Orthopedic AR Management

What is accounts receivable management in orthopedic billing?

Tracking and resolving unpaid claims and balances, from claim status checks to denials, appeals, underpayments, and reconciliation.

Which orthopedic claims should a practice prioritize first?

Those with the nearest deadlines and the best chance of recovery, then by value and age. High-value surgical claims near a deadline come first.

How can a practice reduce claims older than 90 days?

Re-verify status, separate unworked denials from pending claims, correct or appeal where supported, and review AR weekly so balances do not age again.

What happens when a timely filing deadline has passed?

It depends on the payer. Medicare timely filing denials have limited exceptions, such as administrative error or retroactive entitlement. Other payers and contracts vary, and some balances may be uncollectible.

How often should we review AR aging reports?

We suggest monthly at minimum, and weekly for high-value or deadline-sensitive accounts.

When should a practice consider outsourcing AR follow-up?

When staffing, volume, or visibility cannot keep pace with aging balances and denials. Outsourcing supports a practice but does not guarantee results.

Sources: Noridian: Medicare timely filing  |  CMS Claims Processing Manual, Ch. 1  |  CMS Medicare Learning Network

Disclaimer: This article is intended for general educational and informational purposes only and does not constitute legal, coding, reimbursement, or payer-specific billing advice. Orthopedic billing requirements, coverage policies, timely filing limits, appeal deadlines, documentation standards, and reimbursement rules may vary by payer, plan, contract, service, and applicable regulations. Verify the requirements that apply to each claim before taking action. The information provided does not guarantee claim approval, payment, or recovery of outstanding balances. Consult the appropriate payer, qualified billing professional, or legal advisor when necessary.