For many dermatology practices, Accounts Receivable (AR) over 90 days is more than just a financial metric-it is often an early warning sign of revenue cycle inefficiencies. Whether the balance is tied to unresolved payer denials, delayed follow-up, coding inaccuracies, or patient payment challenges, aging receivables can restrict cash flow and increase administrative costs. Unlike specialties that primarily manage office visits, dermatology generates revenue through a combination of evaluation and management (E/M) services, biopsies, lesion removals, cryotherapy, Mohs surgery, pathology, and cosmetic procedures. Each service has unique billing requirements, making AR management particularly complex. Understand What Is Driving Aged AR Many practices focus on the total dollar amount in AR but fail to identify why claims remain unpaid. Breaking AR into categories provides a clearer picture of where revenue is getting stuck. Typical causes include: Claims pending medical records Coding or modifier errors Payer requests for additional documentation Insurance eligibility issues Prior authorization deficiencies Underpayments Patient balances that have not entered a structured collection workflow Once these trends are identified, practices can address the underlying process instead of repeatedly resolving the same issues. Start Following Up Before Claims Reach 90 Days One of the biggest mistakes in AR management is waiting until a claim becomes significantly aged before taking action. Claims should be reviewed within the first 30 days after submission. If a payer has not processed the claim, billing teams should verify claim receipt, review claim status, and resolve any missing information immediately. Early intervention often prevents claims from moving into the 90-day aging category. Many successful practices implement scheduled follow-up intervals rather than waiting for payer responses. Review Denials for Patterns, Not Individual Errors Every denied claim provides useful information. Instead of correcting each denial independently, practices should analyze recurring trends. For example: Are Modifier 25 denials increasing? Is one payer rejecting biopsy claims more frequently than others? Are documentation requests concentrated around specific procedures? Do certain providers generate a higher percentage of coding corrections? Trend analysis allows practices to implement corrective measures that reduce future denials instead of repeatedly addressing the same issues. Improve Clinical Documentation Dermatology reimbursement depends heavily on complete documentation. Procedure notes should clearly support medical necessity while documenting lesion location, lesion size, diagnosis, procedural details, and any required modifiers. Incomplete records often trigger requests for medical documentation, extending payment timelines and increasing AR days. Regular collaboration between providers, coders, and billing specialists helps improve documentation quality before claims are submitted. Separate High-Value Claims from Routine Follow-Up Not every aging claim deserves the same level of attention. Practices should prioritize: High-dollar surgical procedures Mohs surgery claims Multiple procedure encounters Commercial insurance claims nearing timely filing limits Claims approaching appeal deadlines Prioritization allows billing staff to recover larger reimbursements more efficiently while reducing overall financial risk. Monitor Key Revenue Cycle Indicators Reducing AR requires continuous performance measurement. Useful metrics include: Percentage of AR over 90 days Average Days in Accounts Receivable First-pass claim acceptance rate Denial rate by payer Average reimbursement turnaround time Collection rate by insurance category Monthly reporting helps identify whether process improvements are producing measurable results. Educate Billing Teams on Payer Policy Changes Dermatology billing guidelines continue to evolve. Annual CPT updates, ICD-10 revisions, National Correct Coding Initiative (NCCI) edits, and payer-specific policies can all influence reimbursement outcomes. Ongoing education helps billing teams submit cleaner claims, apply modifiers correctly, and respond more effectively to payer edits before they affect collections. Build a Proactive AR Strategy Reducing Accounts Receivable over 90 days is not simply about increasing collection calls. It requires coordinated efforts across scheduling, eligibility verification, documentation, coding, claims submission, denial management, and payer follow-up. Practices that review aging reports regularly, investigate denial patterns, strengthen documentation, and prioritize early follow-up are more likely to maintain healthier cash flow and reduce long-term outstanding balances. A proactive approach to AR management supports both financial stability and operational efficiency, allowing dermatology practices to spend less time chasing unpaid claims and more time focusing on patient care.