Cleaning Up Accounts Receivable in Your Optometry Practice

Every optometry practice has an AR aging report, and most owners look at it the way people look at a messy garage: aware, vaguely guilty, and committed to dealing with it eventually. Here's the uncomfortable physics of receivables: they decay. A claim or balance that's collectable at thirty days is a coin flip at ninety and a writeoff waiting for paperwork at one-eighty. Cleaning up AR isn't an accounting nicety — it's rescuing revenue on a countdown. Here's the workback plan practices actually complete.

First, read the report honestly

Pull AR by aging bucket — 0–30, 31–60, 61–90, 90+ — and split each bucket by responsibility: payer versus patient. This one sort tells you most of what you need. A healthy practice holds the large majority of its AR under sixty days; a swollen 90+ bucket means follow-up stopped happening at some point, and the split tells you where. Payer-heavy aging points at claims that were denied, stalled, or never worked. Patient-heavy aging points at statements that went out late, or never, or without follow-up. Different problems, different fixes.

The 90+ triage

Start with the oldest money, but start smart:

• Sort by dollar value, descending. Twenty percent of the accounts will hold most of the dollars. Work those first — morale on this project matters, and early wins fund it.
• Check timely-filing deadlines immediately. Any claim approaching a payer's filing or appeal limit jumps the queue regardless of size. Deadlines convert "pending" to "never" silently.
• Payer balances: status-check every claim. You'll find four species: never received (resubmit today), denied but never worked (into the denial process — our denial guide covers it), processing-stuck (a phone call with the claim number un-sticks a surprising share), and paid-but-never-posted (a reconciliation problem masquerading as AR).
• Patient balances: a fresh statement with a plain-language explanation, then a call — kind, matter-of-fact, offering a payment plan before being asked. Patient AR responds to human contact far better than to a third identical statement.
• Writeoffs, decided consciously. Some of the 90+ bucket is genuinely gone — filing limits passed, balances too small to chase. Write them off deliberately, with a reason code, so the report stops lying to you about what's really collectable.

Then fix the faucet

A cleaned-up AR regrows within two quarters if the upstream habits don't change — and the habits are the same short list every time: claims out daily and scrubbed clean (fewer denials to age), denials worked within seventy-two hours (nothing ages in a folder), statements on a fixed monthly cycle with a call at sixty days, and — the one that makes the others real — a named owner with protected weekly hours for AR follow-up. In most practices the honest answer to "who owns aged AR?" is "whoever has time," which is how the garage got messy in the first place.

The project-plus-rhythm model

This is why AR cleanup has become one of the most common first assignments for a remote billing assistant: it's a bounded project (the backlog) attached to a permanent rhythm (the weekly follow-up), and both are pure desk work — payer calls, portal checks, statements, notes. A dedicated person can typically work through a mid-sized practice's backlog in a few weeks and then hold the line at a fraction of the hours, and the recovered dollars from the backlog alone frequently cover months of the role's cost. The fuller role is described in our billing-assistant guide.

The aging report is just a to-do list sorted by expiration date. Read it honestly, work it oldest-and-largest first, and give the follow-up a permanent owner — and the garage, for once, stays clean.