Is 120+ day medical A/R still recoverable?
Yes. A meaningful share of insurance claims over 120 days is still recoverable, provided each claim is inside the payer's timely-filing or appeal window. Medicare allows one calendar year from the date of service to file and 120 days from the initial determination to appeal; commercial windows are shorter. The first job is sorting the 120+ bucket into claims that are alive, claims that are dying this month, and claims that are dead.
Which 120+ day claims are alive
| Situation at 120+ days | Recoverable? | Action |
|---|---|---|
| Never received by payer; inside filing limit | Yes | Refile with proof of original submission |
| Denied; inside appeal window | Yes | First-level appeal with documentation |
| Denied; appeal window passed but filing limit open | Sometimes | Corrected claim as a new submission where the payer allows |
| Paid below contract | Yes | Underpayment dispute; contract disputes often have their own window |
| Pending records or authorization | Yes | Supply documentation; request retro-authorization |
| Past filing limit with proof of timely filing | Yes | Appeal the timely-filing denial with clearinghouse acceptance report |
| Past filing limit, no proof; past appeal window | No | Close with reason; adjust off |
The deadlines that decide it
For Original Medicare, CMS requires claims to be filed within one calendar year of the date of service, and the appeals process runs through five levels, beginning with a redetermination that must be requested within 120 days of the initial determination and a reconsideration within 180 days of the redetermination (CMS). Medicare Advantage, Medicaid managed care, and commercial plans set their own windows by contract, commonly 90–180 days to file and 60–180 days to appeal. Every 120+ day claim should carry two dates next to it: the filing deadline and the appeal deadline.
Why appeals on old denials are worth filing
Denials are frequently wrong. An HHS Office of Inspector General review found that 13% of sampled Medicare Advantage prior-authorization denials and 18% of payment denials met Medicare coverage and billing rules (OIG, 2022), and KFF's analyses of Medicare Advantage data show that only a small share of denials are appealed while most appeals succeed (KFF). The obstacle is rarely the merits; it is that nobody filed.
What realistic recovery looks like
On a typical specialty-practice queue, the 91–120 day bucket yields the most per claim, the 121–180 bucket less, and the 180+ bucket the least, because more of it has crossed a deadline. In the sample Recovery opportunity report on our homepage, $340,000 of 90+ day A/R contains about $185,000 of actionable balance and an estimated recovery range of $80,000–$130,000. Your numbers depend on payer mix, denial mix, and how long the queue sat untouched. The only way to know is to sort the report claim by claim, which is what a free A/R recovery audit does.
Do not write off a bucket by age. Writing off "everything over 180 days" throws away the claims with proof of timely filing, the underpayments, and the appeals still inside their window. Write off by reason, claim by claim. See when should a practice write off a claim?
Sources
- CMS, Medicare timely filing requirements: claims must be filed within one calendar year of the date of service
- CMS, Original Medicare (fee-for-service) appeals: five levels; redetermination within 120 days, reconsideration within 180 days
- HHS Office of Inspector General, OEI-09-18-00260 (April 2022): 13% of sampled Medicare Advantage prior-authorization denials and 18% of payment denials met Medicare coverage and billing rules
- KFF, Medicare Advantage prior authorization analyses (requests, denial rates, appeal rates, overturn rates)
Figures attributed to a source are that source's; commonly used benchmarks are labeled as such. Verify deadlines against your own payer contracts.
Related articles
Related services
- Aged A/R recovery — Claims past 90, 120, and 180 days, worked by deadline and recoverability.
- Denial recovery — Authorization, medical necessity, coding, eligibility, timely filing, and underpayment denials.