Recover Revenue Sitting in
Aging Receivables

What fertility A/R recovery is

Fertility accounts receivable (A/R) recovery is the systematic collection of unpaid IVF and reproductive-medicine claims after the first payer response has passed. It combines four distinct workstreams: (1) rebilling clean claims the payer never returned, (2) correcting and resubmitting claims that came back with fixable errors, (3) appealing denials that were adjudicated incorrectly, and (4) transitioning confirmed patient-responsibility balances to patient billing.

A/R recovery is not the same as denial management. Denial management works to prevent a claim from being denied in the first place; recovery is what a fertility practice needs after the denial has already aged past 60 days — when payer follow-up windows are closing, appeal deadlines are counting down, and the claim is at real risk of being written off.

Why fertility claims age past 90 days

Most aged fertility A/R is not the result of one big problem — it is the accumulation of small ones that share a common thread: the claim was accepted by the clearinghouse, the practice moved on, and no one pulled the string when the payment did not arrive. These are the seven patterns we see most often on the aged books we take over:

• Authorization number captured on the wrong claim line
  The auth was obtained but attached to the wrong CPT or the wrong service date, so the payer rejects the line even though coverage exists.
• Coordination of benefits (COB) lag
  The patient has both a primary medical plan and a fertility carve-out through a benefit manager. The claim bounces between payers until COB is on file with both.
• Global-package unbundling errors
  ART cycle services (retrieval, ET, cycle monitoring) are billed line-by-line when the payer expects a bundled package — or vice-versa — producing partial payment and an unresolved residual.
• Facility-vs-professional split not reconciled
  Procedures such as 58322 and 58970 pay on separate claims from the facility and the professional. Only one side gets worked, and the other ages silently.
• Documentation not attached at submission
  Op notes, cycle-day documentation, and medical-necessity letters are required for high-dollar ART claims. Missing attachments trigger a soft denial that ages while the practice waits for a call that never comes.
• Payer downcoding of E/M consults
  99214 consults are downcoded to 99213 without a corrected-claim rebill. The difference sits in unresolved variance until someone reconciles the EOB against the fee schedule.
• Timely-filing lapse on "pending" claims
  The claim was accepted as 'in process' and never worked. By the time the practice notices, the payer's submission or appeal window has closed.

Each pattern has a different recovery path. Authorization and COB issues resubmit cleanly once the correct information is on file. Bundling and downcoding errors need a corrected claim with a fee-schedule comparison. Documentation gaps require clinical support to close — and if the timely-filing window has already lapsed, the recoverable path is a written appeal citing the payer's own submission-acceptance record, not another resubmission.

How we work an aged fertility A/R book

When a practice hands us its aged A/R, the first two weeks are triage, not collection. Aged claims fall into three groups — recoverable from payer, recoverable from patient, and not recoverable — and the collection sequence depends on which group each claim belongs in.

1. Reconcile the ledger against the 835 remits. Every open claim gets checked against the payer's posted electronic remittance. A meaningful portion of “aged” A/R is actually paid, just not posted — the 835 hit lockbox but never reached the practice's ledger.
2. Pull claim status via EDI 276/277. For the remaining open claims, an EDI 276 request returns the payer's current status. This is faster than a portal check and produces a machine-readable record we can act on in bulk.
3. Categorize by recoverability. Denied, never appealed. Rejected at the clearinghouse, never resubmitted. Downcoded, never corrected. Waiting on the patient's COB update. Each category has a different owner, workflow, and deadline.
4. Prioritize by dollar and deadline. A $12,000 IVF cycle claim with 20 days left on the filing window is worked before a $180 monitoring visit at day 45. We publish the working list weekly so the practice sees exactly what is being touched.
5. Escalate on a documented timeline. If two payer touches do not produce movement, the claim goes to a supervisor line. Written status is requested when verbal answers change between calls. A supervisor case number is captured for every escalation.
6. Appeal, then external review. Where an internal payer appeal fails and the plan is subject to the ACA external-review right, we file an independent review organization (IRO) request under PHSA §2719. IRO decisions bind the payer.
7. Close the loop upstream. Every root cause found in the aged book gets pushed back into the workflow that produced it — eligibility, auth, coding, or documentation — so the same claim type does not re-appear in the 90+ bucket next quarter.

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