How to Clean Up Aged AR Before Year-End: An Orthopaedic Playbook for Claims Over 90 Days

The fastest way to clean up aged AR in an orthopaedic practice is to sort every open claim over 90 days by dollar value and by deadline, work the highest-value claims closest to their timely filing or appeal limits first, and fix the root cause behind each denial category so the same claims stop aging next quarter. Doing this in October and November matters because many commercial timely filing windows are 90 to 180 days, Medicare's is 12 months from the date of service, and patient deductibles reset on January 1. Every week of delay turns recoverable revenue into a write-off.

This playbook covers how to triage aged AR, which orthopaedic claim types age most often, and how to keep the over-90 bucket from refilling in 2027.

Why aged AR matters more in orthopaedics

Orthopaedic claims are high-dollar and complex. A single unpaid total joint, spine fusion, or fracture repair claim can be worth more than a week of clinic visits. When those claims age, three things happen:

• Collectability drops. The longer a claim sits, the less likely it is to be paid. Industry experience consistently shows recovery rates fall sharply once claims pass 90 and then 120 days.
• Deadlines expire. Timely filing limits, corrected claim windows, and appeal deadlines run out quietly. Once they pass, the revenue is gone regardless of whether the care was medically necessary and correctly documented.
• Cash forecasting breaks. A large over-90 balance makes total AR look healthier than it is and inflates the revenue leadership expects to collect.

MGMA benchmarks are a useful reference point for how much of your AR should sit past 90 and 120 days. Better-performing orthopaedic groups keep the share of AR over 120 days low and stable. If yours is climbing, the problem is upstream, not in collections.

Step 1: Build an aged AR worklist that sorts by risk, not by age alone

Most practices work aged AR oldest first. That approach wastes time on claims that are already past saving while younger, higher-value claims approach their deadlines.

Pull every open claim over 60 days and add these fields to your worklist:

1. Payer and plan type (traditional Medicare, Medicare Advantage, commercial, Medicaid, workers' compensation, auto/personal injury).
2. Balance and expected reimbursement.
3. Claim status: never submitted, submitted with no response, denied, partially paid, or pending additional information.
4. Denial reason using CARC and RARC codes.
5. Days remaining before the timely filing, corrected claim, or appeal deadline for that payer.

Then sort by days remaining, and within each deadline band, by balance. The top of your list is now high-value claims that are about to become unrecoverable. That is where your best billers should spend November.

Step 2: Know the deadlines that apply to each payer

Timely filing and appeal windows vary widely. Confirm the exact limits in each payer contract and provider manual, but these are the ones to anchor on:

• Traditional Medicare: claims must be filed within 12 months of the date of service. Redetermination requests (the first level of appeal) must be filed within 120 days of receiving the initial determination, and reconsideration requests within 180 days of the redetermination decision, per CMS.
• Medicare Advantage: follows the plan's contract terms, which are often shorter than traditional Medicare for initial filing.
• Commercial payers: frequently 90 to 180 days from the date of service for initial claims, with separate windows for corrected claims and appeals.
• Workers' compensation and auto: governed by state rules and adjuster requirements, and often dependent on documentation of the claim number and employer or carrier details.

Track these deadlines in your practice management system, not in a spreadsheet someone maintains by hand.

Step 3: Work aged AR by category, not claim by claim

Once the worklist is sorted, group claims by root cause. Each category has its own fix, and batching them is far faster than working claims one at a time.

Claims never received by the payer

These are often the easiest money. Check clearinghouse rejection reports for claims that failed front-end edits and were never corrected. Resubmit with proof of timely filing where the original submission date is close to the limit.

Eligibility and registration denials

Wrong member ID, terminated coverage, wrong payer order, and coordination of benefits problems. Re-verify coverage, update the patient's registration, and rebill the correct payer. If coverage was terminated, move the balance to the patient or the correct secondary payer quickly.

Prior authorization denials

Missing, expired, or mismatched authorizations are a leading cause of high-dollar orthopaedic denials, especially when a procedure changes intraoperatively (a planned arthroscopic debridement becomes a meniscus repair, or one level of fusion becomes two). Where payer policy allows, request a retro authorization and appeal with the operative note. Track which payers grant retro authorizations and under what conditions.

Coding and modifier denials

Bundling edits (CARC 97), missing or incorrect modifiers, laterality conflicts, and diagnosis codes that do not support medical necessity. These require a coder, not just a biller. Correct and resubmit where the payer allows a corrected claim, or appeal with documentation when the original coding was right.

Medical necessity denials

Common for advanced imaging, injections, and DME. Appeal with clinical documentation that maps to the payer's coverage policy or the relevant Medicare LCD.

Underpayments

Claims that were paid, but below contract. These sit in AR as small balances and are easy to ignore. Compare payments to the contracted rate and appeal systematically by payer.

Patient balances

After a claim adjudicates, the remaining balance moves to the patient. Year-end is the time to send statements and offer payment plans, before January deductibles reset and patients face new out-of-pocket costs.

Step 4: Write off deliberately, not by default

Some claims are not worth working. Set a written small-balance adjustment policy (for example, balances under a set dollar threshold after a defined number of attempts) and apply it consistently. Document every write-off reason so you can see which categories you are losing.

Be careful with credit balances. Under the CMS overpayment rule, Medicare overpayments must be reported and returned within 60 days of identification. Since January 1, 2025, providers can suspend that deadline for up to 180 days while conducting a timely, good-faith investigation of related overpayments. Year-end cleanup is a good time to clear credit balances along with debit balances.

Step 5: Fix the root causes so the over-90 bucket stops refilling

Cleaning up aged AR once is a project. Keeping it clean is a process. Every category above traces back to something that happened before the claim was submitted:

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• Eligibility denials trace back to registration and verification at scheduling and check-in.
• Authorization denials trace back to prior authorization workflows that do not reconcile the authorized procedure against what was actually performed.
• Coding denials trace back to charts coded under time pressure, inconsistent modifier use, and documentation that does not support the level billed.
• Slow submission traces back to charge lag. If surgical charts sit in a coding queue for a week, every claim starts life already a week old.

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This is where automation changes the math. Maia's AutoCoder recommends CPT and ICD-10 codes, modifiers, and clinical justification inside the EHR before a human coder reviews the chart, which reduces both coding denials and charge lag. Maia's prior authorization reconciliation flags mismatches between authorized and performed procedures before the claim goes out, and its denial appeal automation drafts appeal letters for the denials that still occur. Orthopaedic groupsuse Maia across EHRs including Athena, eClinicalWorks, and coming soon, Epic, ModMed, NextGen, and Tebra.

A year-end aged AR timeline for orthopaedic practices

First two weeks of November. Build the risk-sorted worklist. Identify claims within 30 days of a timely filing or appeal deadline. Assign the highest-value claims to your most experienced staff.

Second half of November. Work claims by category. Batch eligibility corrections, retro authorization requests, and coding corrections. Send patient statements for adjudicated balances.

‍First half of December. File appeals for denials with strong documentation. Follow up on claims with no payer response. Clear credit balances.

‍Second half of December. Apply your small-balance adjustment policy. Report results by category to leadership, with root-cause fixes assigned for 2027.

Metrics to report after the cleanup

Leadership should see more than a lower AR balance. Report:

• Dollars collected from aged AR during the project, by category.
• Dollars written off, by reason.
• Change in the share of AR over 90 and over 120 days.
• Change in days in AR.
• Top three root causes and the owner for fixing each in 2027.

Frequently asked questions

What is considered aged AR in an orthopaedic practice?

Aged AR generally means open claims or balances older than 90 days from the date of service or submission. Most practices also track the share of AR over 120 days, because collectability drops significantly after that point.

What is the timely filing limit for Medicare claims?

CMS requires traditional Medicare claims to be filed within 12 months of the date of service. Medicare Advantage plans and commercial payers set their own limits, often 90 to 180 days, so check each payer contract.

How long do we have to appeal a Medicare denial?

A Medicare redetermination must be requested within 120 days of receiving the initial determination. If the redetermination is unfavorable, a reconsideration must be requested within 180 days.

Should we outsource aged AR cleanup?

Outsourcing can add short-term capacity, but it does not fix the upstream causes. If aged AR keeps rebuilding, invest in eligibility verification, prior authorization reconciliation, and coding accuracy so fewer claims age in the first place.

Why is year-end a good time to clean up AR?

Timely filing deadlines for services from earlier in the year are approaching, and patient deductibles reset on January 1. Collecting patient balances in December is easier than collecting them after patients start a new benefit year.

How does AI help reduce aged AR?

AI coding reduces charge lag and coding denials, AI-assisted prior authorization reconciliation catches authorization mismatches before submission, and AI appeal drafting shortens the time to work denials. Together these reduce the volume of claims that age past 90 days.

The bottom line

Aged AR is not a collections problem. It is the end result of eligibility, authorization, and coding problems that happened weeks earlier. Work the deadline-critical claims now, then fix the upstream causes so 2027 starts with a smaller over-90 bucket.

See how Maia's AutoCoder handles this automatically for orthopaedic practices. Book a demo at usemaia.com.