The Problem:
A leading pain management clinic approached Datatech RCM Solutions with a serious financial challenge — over 1,200 aged claims were stuck in limbo for more than 90 days, totaling $950,000 in unpaid revenue. The delays were straining operations, delaying physician incentives, and putting day-to-day cash flow under pressure.
Aged A/R is one of the most difficult aspects of medical billing. As claims age, their likelihood of reimbursement decreases — especially when denied or unworked. Many RCM vendors deprioritize old claims, but at Datatech, we see aged claims not as losses, but as opportunities for strategic recovery.
🔍 The Root of the Problem
A detailed audit revealed five key issues behind the aged A/R crisis:
- Inconsistent follow-up practices across billing cycles
- Denials left unresolved with no formal resubmission workflows
- Payer-specific submission rules ignored, especially around documentation
- High billing staff turnover, which disrupted knowledge transfer
- Data fragmentation across two systems — an EHR and a separate PM system
This wasn’t a simple backlog fix — it was a systemic issue requiring methodical intervention and payer-specific recovery tactics.
🛠️ The Datatech Solution
To respond swiftly and effectively, we deployed our A/R Recovery Task Force, a specialized team trained to handle high-value, aged A/R recovery with precision.
Our multi-phase approach included:
✅ 1. Aging Report Breakdown
- Extracted detailed aging reports from the PM system.
- Grouped claims into age brackets: 91–120 days, 121–180, and 180+.
- Prioritized claims based on reimbursement value and recovery likelihood.
✅ 2. Payer-Wise Segmentation
- Organized claims by major payers (Medicare, Aetna, UHC, BCBS, Medicaid).
- Analyzed each payer’s timely filing deadlines and denial trends.
✅ 3. Denial Code Analysis
- Flagged rejection reasons using ANSI codes (e.g., CO-16, CO-197).
- Focused on patterns such as invalid modifiers, missing auth, or coding errors.
✅ 4. Real-Time Follow-Up
- Resubmitted corrected claims through the clearinghouse.
- Escalated aged claims directly with payer representatives when needed.
- Coordinated with provider offices for supporting documentation or updated notes.
✅ 5. Documentation & Appeals
- Retrieved clinical notes, authorizations, and medical necessity statements.
- Filed formal appeals with appropriate documentation for high-value cases.
✅ 6. Transparent Reporting
- Delivered weekly A/R dashboards showing recovery progress by claim age and payer.
- Shared audit logs and feedback loops to improve the clinic’s in-house workflow.
📈 The Results
Over a four-week engagement, Datatech RCM Solutions delivered a dramatic turnaround:
| Metric | Outcome |
|---|---|
| Total Claims Reviewed | 1,209 |
| Claims Successfully Recovered | 962 |
| Revenue Recovered | $747,500 |
| Remaining Claims Under Appeal | 177 |
| Recovery Rate | 78.6% |
| Average Days to Recovery | 22 business days |
In addition to financial results, we implemented a permanent denial management structure for the clinic and trained their internal staff to prevent recurrence.
“We were sitting on nearly a million dollars and had no idea how to get it back. Datatech not only recovered the money — they rebuilt our billing system from the ground up.”
– Clinic CFO (Anonymized)
