The short answer: a charge generally can’t be recovered for any part of a loss incurred more than a year before suit is filed, unless a pending claim paused the clock (MCL 500.3145). So the order of work is set by the date of service and by whether each bill is still pending, not by the size of the balance. The rule itself is explained in the one-year-back rule for providers.
Check one date of service
A planning aid, not a deadline calculation. It shows the raw one-year line and does not work out how long a pending claim paused the clock; that depends on the dates and records in each file. Nothing you enter leaves this page.
The five buckets
| Bucket | Which charges | What to do this month |
|---|---|---|
| Urgent | Within about 60 days of the one-year line and not clearly paused | Into the next suit filing, or get them reviewed now |
| Work this month | Two to five months from the line | Fix documentation gaps; decide on a demand or suit |
| Check the pause | Billed with records and never formally denied | Pull proof of what the insurer received and when; follow up in writing |
| Routine | More than five months from the line | Bill with complete records; follow up 30 days after the insurer receives reasonable proof |
| Past the line | Over a year old with no pause you can show | Don’t write off without a review of the submission and denial dates |
Then sort by denial reason
Inside each bucket, group charges by the reason the insurer gave. Each reason needs different records, and some are cheaper to fix than to sue on.
- Fee-schedule reductions: check the Medicare locality and year the insurer used. See the fee schedule and the fee schedule calculator.
- Utilization review (overutilization): see utilization review appeals.
- Priority (“not our insured”): see priority disputes.
- Missing records or proof: see reasonable proof and documentation.
- Policy rescission or fraud claims: see rescission suits that name providers.
A worked example (hypothetical)
Invented for illustration; not a client matter. A therapy clinic runs its aging on November 12 and finds 40 open charges against one insurer. Six have dates of service from early January, so their raw one-year line is about seven weeks out: urgent. Eleven were billed with records last spring and never formally denied: the clinic pulls its portal receipts to show when each arrived. Fourteen were cut to a lower fee-schedule amount: grouped for one recalculation demand. The rest are under five months old and go into routine follow-up.
A monthly routine
- Run the aging by date of service, by insurer.
- Update the status of every charge: billed, pending, formally denied (with the denial date).
- Move charges between buckets; anything newly urgent goes to review that week.
- Keep proof of delivery for every bill and record set: portal receipt, fax confirmation or clearinghouse acknowledgment.
What to send for a free review
Totals are enough to start. Please don’t send patient names or records through the website.
- Open balances by insurer and by age of date of service
- How many charges are billed but not formally denied
- Recent denial letters, by reason (no patient details yet)
- Who at the practice can sign a business associate agreement
Questions people ask us
Does billing the insurer stop the one-year clock?
It can pause it. MCL 500.3145 pauses the one-year period from the time a specific claim is made to the insurer until the insurer formally denies it, and the claim has to be pursued with reasonable diligence. A routine bill without the records the insurer needs, or one you cannot prove was received, is a weak basis for relying on a pause.
Should we sort the aging by billing date or date of service?
Date of service. The one-year-back rule looks at when the loss was incurred, not when you billed it.
Do we have to send patient data to get a review?
No. Totals by insurer and age are enough to start. Claim-level data comes later, through a secure transfer and after a business associate agreement is signed.
