Medical Accounts Receivable Process Template
Four documents and three sheets, ordered by which claims stop being recoverable next rather than by how big they are.
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AR by Payer and Age
Open insurance receivable, ordered by what expires next
One row per open claim. The three columns on the right are derived, and the middle one is the only reason this sheet is not an aging report.
| Claim | Payer | Date of service | Filing window | Window source | Days elapsed | Days to cliff | Balance |
|---|---|---|---|---|---|---|---|
How the derived columns work
Days elapsed is the report date minus the date of service. Days to cliff is the filing window minus days elapsed. Positive means the claim is still recoverable. Zero or below means it is loss, and it leaves open AR so the receivable stops being overstated.
Window source, in order of authority
| Rank | Source | What to record |
|---|---|---|
| 1 | The payer contract | The clause number, so the window can be re-derived |
| 2 | Regulation, for Medicare Part B | One calendar year from the date of service |
| 3 | Unconfirmed | Mark it, use the shortest window in the file, and add the payer to the list to confirm |
Waiting on
Takes one of five values: payer response, corrected claim, records request, patient information, or nothing. A claim waiting on nothing is a claim nobody has decided about.
An accounts receivable process built on aging buckets measures the wrong thing. An insurance claim does not slowly lose value as it ages. It expires, on a date set by the payer's filing window, and after that there is no appeal and nothing to negotiate. Medicare's window is one calendar year from the date of service. Contracted commercial windows are usually shorter, and they are not the same length as each other, which is where an aging report starts lying.
So the register carries a column no aging report has: days to cliff, which is the filing window minus the days elapsed since the date of service. It is per claim, because the window is per payer. An 85 day old commercial claim on a 90 day window has five days left and comes fifth on an age-sorted list. A 351 day old Medicare claim has fourteen. Sorted by cliff they swap, and the five day claim goes to the top.
Dollars are worse. At Kestrel Valley Internal Medicine the four largest open claims carry $13,550 and between 61 and 338 days of runway. The four expiring inside the month total $3,475, and a worklist worked by size from the top reaches none of them. One claim had already expired at $415, denied on day 96 and never worked, which is a handoff problem rather than a follow-up one and belongs with the denial appeal pack.
What's in the pack
How the Filing Cliff Is Computed
The method before the sheets: where each window comes from, the three-rank authority order for the source column, and why neither age nor dollars substitutes for it.
AR by Payer and Age
One row per open claim carrying the filing window, the clause it came from, days elapsed, days to cliff, and what the claim is waiting on.
Worklist Prioritization
The week ordered by cliff, with the rank each claim would have had under a dollar sort and an age sort in adjacent columns so the disagreement is visible.
Follow-up Procedure
Five cliff bands with a different action in each, including the rule that inside 14 days you refile rather than buy a status answer you no longer have time for.
Payer Escalation Contacts
One page per payer, with the filing clause, the corrected-claim method, and the prompt payment obligation that turns a phone call into a letter.
Write-off Policy
Expired and elective write-offs kept apart, because both reduce AR by the same dollar and only one of them was a decision anybody made.
Recovery Tracking
One row per closed claim with days to cliff at first touch, which separates a claim lost inside the practice from one that never reached the worklist.
Handoffs that keep this register honest
A claim paid below contract is not a receivable, it closed at the wrong number, so it goes to the underpayment recovery pack. A balance after adjudication goes to the patient billing pack.
How to use it
- 1
Open in River, or download it
Open the pack in River and let the agent build the register from your own AR export, or download the blank Word and CSV files instantly and fill them in yourself.
- 2
Send the AR with dates of service
Claim, payer, date of service and balance is enough. The date of service is the one field the cliff cannot be computed without, so an aging bucket export will not do.
- 3
Pin down each payer's window
From the contract clause where there is one, from regulation for Medicare, and marked unconfirmed with the shortest window in the file where the contract is silent.
- 4
Work the cliff, then read the expired list
The worklist reorders itself weekly. Once a month the expired rows get a cause naming the step that was skipped, and the causes name the process fix.
Frequently asked questions
Is this template free?
Yes. The four documents and three sheets download as Word and CSV files with no signup and no card. "Edit with AI" is the optional path for practices that want the cliff column computed from their own AR export. The rest of the library is at the template library.
What format are the downloaded files?
Word documents for the follow-up procedure, the escalation contacts, the write-off policy and the method note, plus CSV for the three registers, zipped into one file. They open in Word, Pages, Google Docs, Excel, Numbers and Sheets with nothing to convert first.
What is days to cliff, exactly?
The filing window minus the days elapsed since the date of service, computed per claim because the window is per payer. A claim with a positive number is still recoverable. A claim at zero or below is loss, and the register moves it out of open AR so the receivable stops being overstated.
Where do the filing windows come from?
From the contract clause, quoted in the register so the number can be re-derived. Medicare is the exception: one calendar year from the date of service by regulation, not by contract. Where a contract is silent the claim is marked unconfirmed and gets the shortest window in the file, which is the safe direction.
Does this replace our aging report?
No, it re-sorts it. The aging buckets stay, because month-end reporting needs them. What changes is the work order: the same claims ranked by what expires next, with the rank each one would have had under a dollar sort and an age sort in adjacent columns, so the disagreement is visible.
What about a clean claim the payer is just sitting on?
That is an escalation rather than a follow-up, and it needs a written obligation behind it. A Medicare Advantage plan's contract with CMS must provide that it pays 95 percent of clean claims within 30 days of receipt for the claim types named there, with interest owed after that.
Does this work denials or patient balances?
Neither. A denied claim needs an argument written against its reason code, which is the denial appeal pack, and a whole remittance gets ranked first by remittance and denial triage. This register keeps the filing clock on those claims and nothing else.
Find out how much of your AR expires this month
Send the open claims with their dates of service and whatever you know about each payer's filing window. The first thing back is the cliff calendar and the expired list.
Edit with AI