Claims are leaking revenue.

According to recent reporting, claim denials and data errors drive billions in improper payments and extend Days in Accounts Receivable Follow-up across hospitals, creating a direct drag on cash flow. [CMS FY2024 improper payments fact sheet](https://www.cms.gov/newsroom/fact-sheets/fiscal-year-2024-improper-payments-fact-sheet) shows the scale and cost of avoidable payment losses.

In this guide you’ll learn a practical, repeatable AR follow-up method called PRIORITIZE for Revenue Cycle Management (RCM).  

You’ll get step-by-step implementation actions, KPIs, templates, and a real-world operational example to help you reduce bad debt and speed cash collection.

Why active AR follow-up matters today

Passive billing lets small errors become big losses.

When claims sit unverified, payer behaviors — delayed adjudication, missing authorizations, and simple data mismatches — create predictable leak points that become denials. [Becker’s “State of Claims” 2024](https://go.beckershospitalreview.com/financewp/the-state-of-claims-2024-bad-data-is-causing-denials-and-its-getting-worse) documents how poor data and missing authorizations are driving denials up.

The mechanics are simple.

A denied claim delays cash.

It triggers rework and ties up staff time.

Dr. Sarah, a hospital administrator, put it plainly: “We’re firefighting claims, not preventing them.”

That image explains why passive follow-up costs more than people realize.

Benchmarks help you set targets.

Use HFMA guidance to standardize denial metrics and compare performance. [HFMA denial metrics guidance](https://www.hfma.org/guidance/standardizing-denial-metrics-revenue-cycle-benchmarking-process-improvement/) is a reliable reference.

AR Follow-up method — PRIORITIZE explained

PRIORITIZE is a simple operating method: Prioritize, Review, Identify, Outreach, Track, Iterate, Zero-out escalations, Educate.  

It’s designed for clarity and action across your AR team.

Prioritize accounts by risk and value

Use a three-tier triage matrix: High (90+ days or high balance/high-risk payer), Medium (31–89 days), Low (0–30 days or small balances).  

Key ranking criteria: age, balance, payer denial history, clinical complexity, and contract rate. Pull a sample AR aging report from your PM/EHR (Epic, Cerner) to build the matrix. [Epic](https://www.epic.com/)

Practical example: if an account has a $12,000 balance and a 0.5 recovery probability, score it as $6,000 recovery potential — that’s a high priority.  

Use that math to set daily pick lists for your collectors.

Review and validate documentation thoroughly

Before any outreach, confirm charting, coding, and authorization are present. Missing items cause many denials.

Five common documentation misses:

- missing prior authorization

- wrong modifiers

- incomplete medical-necessity notes

- mismatched patient demographics

- uncaptured consent

Use CDI best practices from AHIMA for checks and training. [AHIMA CDI resources](https://www.ahima.org/)  

Also review CMS's CERT program findings for common error categories that drive denials. [CMS CERT program](https://www.cms.gov/data-research/monitoring-programs/improper-payment-measurement-programs/comprehensive-error-rate-testing-cert)

Assign roles: one clinician reviewer for medical necessity, one coder for CPT/ICD validation, and one admin for authorization checks. That division reduces rework.

Identify root causes and expected recovery

Classify denials by root cause: eligibility, authorizations, coding, bundling, or payer-system errors.  

This classification lets you focus on high-recovery streams first. Use a simple scoring rule: recovery probability × outstanding balance = priority score.

Example calculation:

- Balance = $10,000

- Estimated recovery probability = 0.6

- Priority score = $6,000

That score guides where you spend limited specialist time.

Outreach, tracking, and escalation rules

Design a scripted outreach flow:

- Days 0–30: automated claim-status polling and first contact.  

- Days 31–60: active outreach with required documentation requests.  

- Days 61–90: assemble appeal packet and assign to denials analyst.  

- 90+: escalate to clinical reviewer or legal if recovery remains viable.

Anchor Medicare cases to CMS appeals timelines for accurate deadlines. [Medicare appeals guidance](https://www.cms.gov/medicare/appeals-grievances/fee-for-service) | [Medicare Parts C & D appeals](https://www.cms.gov/MMCAG/)

Sample outreach scripts (copy-and-use)

Phone script — initial collector call (Days 31–60):

“Hi, this is [Name] from [Hospital]. I’m calling about claim [Account ID]. We have documentation to support medical necessity and a corrected authorization. Who can I email the packet to for reprocessing?”

Appeal email — Days 61–90:

“Subject: Appeal for Claim [Account ID] — Documentation Attached

Body: Attached are the clinical notes, authorization, and corrected coding. Please confirm receipt and advise next steps for reconsideration.”

Create a simple tracking table. Include these fields:

For templates and operational best practices, TechTarget’s RevCycleManagement hub offers practical how-to articles. [TechTarget RevCycleManagement](https://www.techtarget.com/revcyclemanagement)

Step-by-step implementation: from process to KPIs

Build the operational playbook

Write SOPs for each priority tier: who does what and when.  

Include outreach scripts, appeal letter models, and a five-point documentation checklist (eligibility, auth, coding, charting, patient info). Use the Center for Medicare Advocacy packets for appeal templates and sample language. [Medicare self-help packets](https://medicareadvocacy.org/take-action/self-help-packets-for-medicare-appeals/)

Pilot the playbook on one service line for 30–60 days.

Measure recovery, time-to-resolution, and denial reasons.

Adjust scripts before scaling.

Pilot micro-plan (example cadence):

- Week 1: baseline AR extract and top-50 triage.

- Week 2–4: daily outreach to high-priority accounts.

- Week 5–8: evaluate appeal outcomes and refine scripting.

- Day 60: review KPIs and decide next steps.

Technology and automation checklist

Look for automation in three places: status tracking, outreach reminders, and appeal generation.  

Compare lightweight automations against full RCM platforms. Analytics-driven denial discovery examples show what’s possible; review FinThrive’s announcement for context. [FinThrive analyzer](https://finthrive.com/news/finthrive-debuts-denials-and-underpayments-analyzer/)

If you can, add FHIR-based checks for provider and eligibility validation. Reference HL7 guides for integration details. [FHIR Argonaut guide](https://www.fhir.org/guides/argonaut/pd/future.html) | [US NDH IG](https://build.fhir.org/ig/HL7/fhir-us-ndh/branches/master/index.html)

Set realistic timelines: 60–90 days for basic automation; 4–6 months for full integrations.

Team roles, training, and cadence

Define roles: AR specialists (daily outreach), denials analyst (appeals and root-cause), clinical reviewer (medical necessity), escalation owner (contracts/legal).  

Run a 90-day training plan including role-play and coding refreshers. Use a weekly cadence:

- Monday quick-huddle to triage top 20 accounts.

- Weekly reporting to share progress.

- Monthly deep-dive on trends and root causes.

Survey results show denial management needs specialized skills — use that rationale to justify training or hiring. [Survey summary](https://www.techtarget.com/revcyclemanagement/news/366600387/Denial-Management-Calls-for-More-Expertise-Survey-Says)

KPIs, dashboards, and continuous improvement

Track these eight KPIs: Days in AR, denial rate, percent appealed, appeal success rate, cash collected, net collection rate, AR aging by payer, and time-to-resolution. Use HFMA benchmarks to set targets. [HFMA resources](https://www.hfma.org/)

Quick KPI guide:

- Days in AR — average time to collect; lower is better.

- Denial rate — percent of claims denied at first pass.

- Percent appealed — share of denials that enter the appeal process.

- Appeal success rate — percent of appealed claims that recover funds.

- Cash collected — dollar amount collected from AR follow-ups.

- Net collection rate — billed charges converted to collected cash.

- AR aging by payer — where time is accumulating.

- Time-to-resolution — median days from denial to cash or write-off.

Design dashboard visuals: trend lines for Days in AR, heat maps for denial reasons by payer, and leaderboards for collector performance. Hold monthly retrospectives and update scripts, priority rules, and tech settings based on what the data shows.

HealthyFort Services — operational example and plug-in

HealthyFort Services applies the PRIORITIZE method to automate claim tracking, score accounts by recovery risk, and route complex appeals to specialized teams. The service integrates with EHRs such as Epic and Cerner to pull status feeds and documentation automatically, cutting manual lookups and errors. [Epic integration reference](https://www.epic.com/)

Here’s a compact vignette: a mid-sized hospital piloted automated claim polling and prioritized high-risk accounts. Within six months the team shortened time-to-resolution and materially improved collections. Manual appeal prep that once took 45–60 minutes fell to under 10 minutes with templated, auto-populated appeals.

If you want to see the PRIORITIZE method applied to your systems, request a short demo or case study to review specific integration points and expected impact.

FAQs — Practical answers for AR follow-up

Q: What AR follow-up cadence should a mid-sized hospital use?  

A: Days 0–30: verification and first contact. Days 31–60: active outreach and fixes. Days 61–90: prepare appeals. 90+: escalate. Align Medicare cases to CMS appeals timelines. [CMS appeals](https://www.cms.gov/medicare/appeals-grievances/fee-for-service)

Q: Which denials should we appeal vs. write off?  

A: Appeal when documentation or authorization can be corrected and the recovery exceeds appeal cost. Write off when recovery probability is low and the collection cost outweighs payment.

Q: What minimal tech stack starts AR automation?  

A: 1) claim status polling, 2) document repository linked to claims, 3) outreach/reminder automation, 4) analytics to classify denials. Use TechTarget for tool research. [TechTarget RevCycleManagement](https://www.techtarget.com/revcyclemanagement)

Q: How do I measure ROI for an AR follow-up program?  

A: Simple formula: (Recovered Cash + Reduced Days-in-AR Value) − Program Cost = Net Benefit. Use a ballpark estimate of daily cash value per AR day for quick projections.

Q: How do I get CFO/IT/compliance buy-in?  

A: 1) Propose a 30/60/90 pilot with clear KPIs. 2) Map integrations and security needs upfront. 3) Use HFMA/CMS benchmarks to show potential recovery. [HFMA guidance](https://www.hfma.org/)

Q: What resources track denial trends and policy updates?  

A: Monitor CMS publications, HFMA updates, Becker’s revenue-cycle coverage, AHIP payer bulletins, and AAPC/AHIMA resources. [CMS improper payments](https://www.cms.gov/newsroom/fact-sheets/fiscal-year-2024-improper-payments-fact-sheet) | [AAPC denial guide](https://www.aapc.com/resources/guide-to-claim-denial-management) | [Becker’s finance hub](https://www.beckershospitalreview.com/finance)

Q: What outreach templates should we start with?  

A: Start with two replicable assets: (1) quick collector phone script for Days 31–60, and (2) an appeal email template for Days 61–90. Use the samples above and adapt payer contact points.

Conclusion — Next steps

Proactive, prioritized AR follow-up reduces denials and bad debt while improving cash flow.  

Run a 30-day triage pilot using the PRIORITIZE checklist, measure Days in AR and recovered cash, and then decide what to scale. Use the pilot micro-plan and KPI targets above to decide. If workflow automation and templated appeals free up specialist time and produce measurable recovery, consider a broader rollout with an outcomes-focused partner such as HealthyFort Services.

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