AR Cleanup: What It Is and Whether Your Practice Needs One

Pull your aged accounts receivable (A/R) report. If claims older than 90 days make up more than 15 to 20 percent of your total receivables, you have a problem. It's probably been growing quietly for months.¹

AR cleanup is the process of reviewing all outstanding claims, finding out why they haven't been paid, and taking corrective action to recover that revenue. For behavioral health practices, it's more complicated than most billing guides let on.

This post covers what AR cleanup actually involves, how to spot the warning signs before things get worse, and what a real recovery process looks like. We'll also get into the kind of ongoing process that keeps the backlog from coming back.

What Does "AR Cleanup" Actually Mean?

Accounts receivable represents money your practice has earned but hasn't yet collected. When claims sit unpaid, they "age" into buckets: 30 days, 60 days, 90 days, 120-plus days. The older a claim gets, the harder it is to recover.

AR cleanup is the systematic effort to work through that aged inventory. That means identifying why each claim hasn't been paid, fixing the underlying problem (whether it's a coding error, a missing modifier, or a lapsed authorization), and resubmitting or appealing until you've collected what you're owed — or made a clear decision to write it off.

It sounds manageable on paper. Telehealth claims require specific place-of-service codes and modifier documentation. Prior authorization timelines have hard deadlines that, once missed, are nearly impossible to appeal.

Consider a group practice in the Twin Cities that pulls their aged AR for the first time in six months. They find $38,000 in claims older than 90 days, most traced back to a single provider whose telehealth sessions lacked the correct telehealth modifier. That coding gap had been generating quiet rejections for months before anyone noticed.

5 Signs Your Accounts Receivable Needs Attention

You're not alone if your AR has slipped. It happens to many practices, especially during periods of growth, staff turnover, or software transitions. Here are the signs that a cleanup is overdue:

• Claims older than 90 days exceed 15 to 20 percent of your total receivables. An AR aging report will show you exactly where you stand.
• You know your denial rate is high, but you're not systematically working appeals. Logging a denial without following through lets revenue slip permanently.
• Your billing team is fully occupied with new claims and has no bandwidth for follow-up. When current work crowds out older AR, the backlog compounds quietly.
• You've recently changed software, billing companies, or added new providers. Transitions are the most common trigger for AR pileup. Things fall through in the handoff.
• Payments feel slow, but you can't explain why. No root-cause visibility means the underlying issue keeps generating new denials.

Here's a scenario that plays out often: a solo ARMHS provider in Illinois notices payment volume has dropped over three months. A billing review uncovers a prior authorization lapse — sessions were rendered after the authorization expired, and the resulting denials were never reworked. The claims are still within the appeals window, but barely.

How to Clean Up Aging Claims: A Step-by-Step Overview

Accounts receivable cleanup for behavioral health practices isn't a single action. It's a structured process.

Step 1: Pull a full aged AR report. Segment it by payer, provider, and age bucket. You can't prioritize what you can't see.

Step 2: Separate insurance AR from patient AR. These require completely different follow-up strategies. Insurance AR means payer calls, appeals, and corrected submissions. Patient AR means statements and collection policies.

Step 3: Prioritize by dollar value and recoverability. Start with high-value claims still within timely filing windows. Timely filing is the deadline insurers set for submitting a claim after the date of service. Once that window closes, the claim is generally uncollectable. Don't spend hours on small-dollar claims that are past the appeal deadline.

Step 4: Do root-cause analysis. Are multiple claims being denied for the same reason? A single coding pattern or payer rule change can generate hundreds of denials before anyone catches it. Cleanup without addressing the root cause just produces the same problem again.

Step 5: Work the claims. Corrected submissions, formal appeals, documentation updates, payer calls. This is the labor-intensive part.

Step 6: Decide what to write off. Some aged claims aren't worth pursuing. Having a clear threshold prevents wasted time and keeps your AR metrics accurate.

Take a Minnesota group practice with 10 providers that brings in outside help to address $75,000 in aging AR. Root-cause analysis reveals that one Medicaid managed care payer changed their modifier requirements six months earlier without notice. Resubmitting corrected claims with updated documentation recovers the majority within 60 days.

Why Behavioral Health AR Cleanup Is More Complex Than It Looks

Most billing guides treat AR cleanup as a general medical billing problem. For behavioral health, that framing misses some significant realities.²

A billing approach that works for one payer can generate denials for another. Errors compound quickly when you're billing 20 or 30 sessions per provider each week.

Telehealth claims add their own layer. Place-of-service codes (02 vs. 10) and documentation requirements for synchronous services vary by payer and have shifted frequently in recent years. A single misconfigured claim template can generate months of quiet rejections before anyone spots the pattern.

Prior authorization management is more intensive in behavioral health than in most specialties. Long-term treatment plans, weekly sessions, and frequent renewals create multiple points where an authorization can lapse. When it does, claims get retroactively denied, often long after the service was rendered.

Clinical documentation requirements add one more layer. Missing medical necessity language, unsigned notes, or incomplete session documentation can invalidate a claim even when the coding is correct.

After the Cleanup: Building A/R Management That Doesn't Break Down Again

Aged AR recovery is a one-time intervention. Without structural changes, the backlog returns.

The fix is ongoing A/R management: a monthly review of aging claims before they cross the 90-day threshold, combined with clean submissions from the front end — eligibility checks, authorization tracking, correct coding from the start. The goal is to reduce days in AR consistently, not just clear today's pile.

A named person responsible for your AR changes the dynamic entirely. When a specific coordinator watches your account month to month, patterns get caught early. A new denial trend surfaces in two weeks rather than two months. That's the difference between proactive monitoring and reactive cleanup.

At BreezyBilling, monthly A/R audits are built into every account, not treated as an add-on. Your dedicated coordinator reviews aging claims, catches emerging patterns, and flags issues before they compound into a backlog. Combined with our timely filing commitment — if we miss a filing deadline, we cover the lost claim — you have accountability built into the relationship from the start.

If the real goal is to reduce days in AR over time, the answer isn't a better cleanup process. It's a better ongoing process.

Final Thoughts

AR cleanup is the work of recovering what your practice is owed. But if you're doing a full-scale cleanup more than once, something upstream has broken down.

The real goal is building ongoing denial tracking and A/R monitoring that keeps claims from aging in the first place. That requires consistent follow-up, root-cause visibility, and someone accountable for the numbers every single month.

If you're staring down an AR backlog and aren't sure where to start, BreezyBilling is here to help. Reach out to learn how our relationship-based approach to behavioral health billing keeps practices out of cleanup mode.

Footnotes

1. 5 Proven Strategies to Reduce Days in Accounts Receivable for Behavioral Health Providers — Integrity Billing Company, 2024

2. Behavioral Health Billing: Reduce AR Days & Denials — Cloud RCM Solutions, 2024