Most practices don’t lose Q4 revenue in one big disaster. They bleed it out — a denied claim here, an aging AR balance there, a patient whose deductible resets in January before the old balance ever got collected. By the time December 31 closes the book, the money is gone and there’s no mechanism to recover it.

Here’s what sharp billers do between now and year-end.

Step 1

Pull Your 90+ Day AR and Work It Like a Collections Sprint

Before you touch anything else, run an aging report filtered to balances 90 days and older. These are not “pending” claims — they are revenue that is quietly expiring. Commercial payers typically allow 90 to 180 days from the date of service; Medicare allows one year. Check each payer’s filing limit first. Work the claims still inside the window before anything else.

For anything sitting past 90 days, you need a specific answer: Was it denied? Did it process and underpay? Is it still floating in limbo?

Work these claims in order of dollar value, not date. A $12 balance from March is noise. A $1,400 balance from July is a problem that still has time to fix.

What to look for: Claims with no EOB response. These didn’t deny — they disappeared. Call the payer, get a reference number, and resubmit with proof of timely filing.

Step 2

Audit Your Top Denial Codes Before Year-End

Pull your denial data for Q1–Q3 and find your top three CARC/RARC codes. If the same code is showing up repeatedly across payers, that’s a systemic issue — meaning it’s still happening on claims you haven’t received back yet.

Fix the upstream problem in October and you stop the bleeding before year-end. Wait until January and you’re playing defense on Q4 revenue you’ll never recover.

The November Insider Pulse (November 1) goes deep on denial-code patterns and what each one is actually signaling — including the ones that look like coder errors but aren’t.

Step 3

Collect Patient Balances Before the January Deductible Reset

Come January 1, deductibles reset to zero — patients are back to owing new out-of-pocket costs before insurance pays anything. Old balances that felt manageable in November become much harder to collect in February when patients are already facing new expenses.

If you have outstanding patient balances from anyone seen after July, send statements now and make it easy to pay. Phone, portal, or text link (where you have consent to text). Every week you wait is a week closer to the reset.

Don’t leave this to the front desk to “bring up at checkout.” Run a report of patient balances over $50 from the last 90 days and send a targeted statement batch this week.

Step 4

Check Your Credentialing Expiration Dates Before December

Nothing kills Q4 revenue like a provider whose CAQH profile lapsed or a payer credentialing cycle that quietly expired. Revalidation notices get buried in email. Payers don’t always tell you — they just start downgrading or rejecting claims.

Pull your provider roster and check CAQH attestation dates — re-attestation is required every 120 days. Check payer-specific revalidation requirements for Medicare and Medicaid, which carry hard deadlines and loss of billing privileges if missed. If you find a gap, start the process now: credentialing typically takes 60 to 90 days for Medicare and 90 to 120 days for most commercial payers.

Insider Pulse Issue 05 covered the Q4 credentialing window in detail — including the providers most at risk and the exact action checklist. Read it at cleanclaimrx.com/pulse-05.

Q4 doesn’t have to be a scramble. It just requires looking at the right numbers while there’s still time to act on them.

Go get your money.
— Lex | CleanClaimRx Insider
The Insider is published bi-weekly. For monthly industry macro analysis, read the Insider Pulse.