- September 30, 2026
- Posted by: Josh Knoll
- Category: Radiology Billing
A clinic can perform thousands of imaging studies each and every month, submit claims properly and still have a cash-flow issue. Do you know why? The reason is that aged accounts receivable (A/R).
A claim remaining unpaid for 30 days may require a routine follow-up. At around 60 to 90 days, it requires very close attention by understanding the root cause. Once the aged claims reach 120 days or more, the account needs a different investigation level. The longer a claim remains unresolved, the more likely is that the account involves a denial, authorization problem, missing documentation, payer issue, incorrect coding and a follow-up gap.
It is important to understand that 120 days is not a universal deadline. All the payer rules vary, and Medicare Fee-for-Service generally has a 12-month timely-filing limit for all the claims. This is where the need for a radiology billing company comes into the picture.
All the unpaid claims over 120 days are a warning sign because unresolved accounts may be approaching payer-specific filing, reconsideration, appeal, or documentation deadlines. For imaging providers, the question is not simply, how many aged claims do we have? The better question is how much of our aged balances can still be recovered, and what is preventing us from collecting it?
What Is 120+ Day A/R in Radiology Billing?
Aged claims are the money owed to an imaging clinic for services already been provided but not collected. It includes unpaid insurance claims, pending balances, and accounts waiting for additional documentation process. A typical accounts receivable aging report may divide outstanding balances into categories such as:
- 0–30 days
- 31–60 days
- 61–90 days
- 91–120 days
- 120+ days
- 180+ days
The 120+ day bucket deserves special attention for clinics. These accounts have already moved well beyond the normal initial claim-processing cycle and should not simply continue aging without a documented recovery strategy.
Why Do Radiology Claims End Up in 120+ Day A/R?
There is rarely one single reason. In most practices, aged claims are the result of several problems occurring at different points in the revenue cycle.
1) Unresolved Claim Denials
Denials are one of the most obvious contributors to aging claims. An imaging claim may be denied because of medical necessity, coding, eligibility, authorization, documentation, coverage limitations, duplicate billing, incorrect claim information, or other payer-specific requirements. The important point is that a denied claim is not automatically a lost claim.
CMS has stated that Medicare providers have a formal appeal pathway for both coverage and payment decisions. For Original Medicare, the first appeal level is a redetermination performed by the Medicare Administrative Contractor. A party generally has 120 days from receipt of the initial determination to request a redetermination.
The problem is that denial sitting untouched for weeks can become much harder to work. A strong accounts receivable process therefore does not treat denial management as an occasional administrative task. It treats it as a continuous recovery process.
2) Prior Authorization Problems in Radiology Billing
Imaging is particularly exposed to prior authorization issues because many imaging services may be subject to payer-specific authorization requirements. The AMA’s recent physician surveys show just how significant the administrative burden can be. In its 2025 survey, 95% of physicians reported that prior authorization delays access to necessary care; 79% said patients abandon treatment because of authorization challenges, and 32% reported that prior authorization requests are often or always denied.
For practices, authorization problems can create downstream revenue problems as well. A missing authorization, an authorization for the wrong procedure, an expired authorization, or a mismatch between the authorized service and the submitted claim can all create payment issues. That means prior authorization is not just a scheduling or clinical workflow issue. It can become an aged claim problem months after the imaging service has been performed.
3) Incorrect or Missing Documentation in Radiology Billing
The reimbursement process depends heavily on appropriate documentation. The documentation problems have been constantly affecting Medicare payment for diagnostic radiology services for more than a decade now. In one OIG review of CT, MRI, and X-ray services in hospital outpatient emergency departments, some claims lacked physician orders or documentation supporting that interpretation and reporting had been performed. And it is still a problem even today which most of the clinics are facing these days.
More broadly, HHS OIG states that claim reviews may consider whether services were medically necessary, appropriately documented, correctly coded, submitted, and reimbursed. For an aged account, this matters because the billing team may eventually discover that the payer is waiting for a record, order, report, or other supporting documentation before the claim can be resolved.
4) Coding and Modifier Issues
The billing process often requires careful attention to how services are represented on a claim. CMS has recognized that imaging services and diagnostic tests have both professional and technical components in which modifiers 26 and TC are being used for the applicable services.
When both components are not properly reported or coding doesn’t match the documentation process, the payment can get delayed, reduced, or eventually denied. The providers need to learn a simple lesson in which a technically small error can create a higher accounts receivable problem later.
5) Insurance Eligibility and Coverage Problems
Incorrect insurance information, inactive coverage, coordination-of-benefits issues, or changes in a patient’s health plan can also push claims into older aging receivable buckets. These issues often begin during registration or scheduling and can continue into the post-submission stage, where radiology billing outsourcing teams work to resolve claim-related problems.
6) Payer Processing Delays
Not every aging account is the result of an error a provider creates. Some of the claims may be pending with the payer, need additional information or repeated follow-ups before clinics get a meaningful response. This is why simply looking at the aged claims amount is not enough. Clinics need to know why each and every individual balance is aging.
Why 120+ Day A/R Is Harder to Recover
This is where aged accounts receivable becomes a real business problem. The older an account becomes, the more complicated the recovery process can be.
1) Documentation Becomes Harder to Obtain
An older claim may require records from the referring provider, hospital, imaging facility, or another department. Tracking information several months after the date of service can take much more effort than resolving the issue shortly after the claim is denied.
2) Appeal Deadlines Become More Important
Different payers and coverage types have different appeal requirements and timeframes. For original Medicare, a provider gets around 120 days to request for a first-level redetermination after getting the initial determination. Medicare Advantage appeals follow a different process. For applicable Level 1 appeals, the 2026 CMS flowchart generally identifies a 65-day filing period beginning on the date of the notice. The exact pathway and deadline depend on the party appealing and the type of determination. This is the reason you need to take the help of radiology billing solutions to streamline your claim submission process.
3) Claim History Gets Messier
A 120+ day account may have already gone through several stages:
Original submission → rejection → correction → denial → resubmission → payer request → appeal → partial payment → remaining balance
Without good account notes and documentation, even experienced billing staff can spend significant time figuring out what happened.
Strategies to Recover 120+ Day A/R in Radiology Billing
There are several strategies starting from prioritizing accounts to following up until the account reaches the right solution.
1) Prioritize Accounts Instead of Working Them Randomly
Start with the right accounts having meaningful balances and a realistic revenue opportunity. Review the denial reason, claim history, payer response, and supporting documentation. Understand if the account needs correction, resubmission, or an appeal.
2) Investigate Underpayments
A claim marked “paid” is not necessarily a fully resolved account. Compare the payment with the expected reimbursement, contractual terms and applicable payer rules. Small underpayments repeated across hundreds of claims can become a substantial revenue leak.
3) Verify Claim and Payer Status
For pending accounts, determine what is actually happening.
- Was the claim received?
- Was it denied?
- Is additional information required?
- Was payment issued but not posted correctly?
The answer should be documented rather than assumed.
4) Resolve Documentation and Coding Issues
When the payers understand the whole coding problem, it is important to work backward to determine what is properly missing or incorrect. This is especially important because CMS payment processes include claim edits that can reject or deny claims when requirements are not met. This is where reliable radiology billing services become critical to maintaining a healthy revenue cycle.
5) Follow Through Until the Account Reaches a Clear Resolution
Just getting an update from the payer should not be the final outcome recorded in the system. A strong accounts receivable workflow should aim for a clear result in which no claim denial occurs. Every account should take the next step in the billing process.
In-House vs. Outsourced A/R Recovery in Radiology Billing
Managing your radiology practices comes with various hurdles where your internal billing team might have strong knowledge of the practice, providers, systems, and payer relationships. However, they may lack the bandwidth or time to deal with current claims, charge entry, payment posting, patient inquiries, and daily denial management. As an radiologist, this might backfire your finances. An outsourced recovery team can be more structured specifically around aged accounts. While the right approach depends on the practice’s size, internal resources, aged claim profile, and recovery needs. An experienced coders or billers managing your aging AR do make a differences.
When Should Practice Consider Outsourcing A/R Recovery?
Outsourcing may become worth considering when a practice has a large backlog of aged accounts, limited internal staff capacity, or high-value claims that remain unresolved. For example, a practice may have a capable billing team that handles daily claims extremely well but simply does not have enough time to work on thousands of historical accounts. That’s an important distinction as the question is not whether the existing team is doing a bad job. The question is whether the practice has enough dedicated capacity to recover the radiology billing amount that has already aged.
Recover Your Aged A/R With SunKnowledge
Managing all the current claims is one part of the RCM cycle. SunKnowledge helps clinics address the completely other side of the equation which includes unresolved accounts receivable sitting on the books. Our revenue recovery approach can support providers with:
- Aged claims analysis
- Insurance claim follow-up
- Denial and appeal support
- Underpayment identification
- Payer follow-up
- Claim status investigation
- Documentation and correction follow-up
- Aged claims analysis and reporting
Instead of allowing 120+ day accounts to remain buried in an aging report, a dedicated recovery process can identify which accounts deserve attention, determine what is preventing payment, and move each account toward resolution.
We can help to reduce your operational costs by 80% and provide 10% buffer resources to make sure no employee shrinkage occurs. SunKnowledge also provides a dedicated account manager and the best infrastructure setup according to the client’s needs. Our experts will also provide customized reporting and have quick turnaround time in case you face any issues. We also help with gastroenterology, cardiology, infusion, DME, and many more specialties at only $7 per hour.
Have 120+ Day Accounts Receivable Sitting on Your Books?
Your aged A/R may represent revenue that has already been earned but never collected. Let a reputed radiology billing outsourcing company like SunKnowledge help you identify the accounts worth pursuing and build a structured strategy to recover the lost money for your clinic. Looking for the perfect AR strategy, our expert can reduce the bucket in no time when it comes to dealing with aging accounts here. Also, partnering with us give you added advantages of a seamless revenue cycle operation.