A/R Follow-Up Capacity Planning

There is no honest general answer, and a number here would be actively misleading. The figure depends on payer mix, specialty, balance sizes, how much of the population is deadline-bound, and above all on what a touch costs in that practice — which varies enormously depending on whether status is established electronically or by telephone. The defensible substitute is a model built from four locally measurable quantities: what enters the follow-up population, what leaves it and how, what each type of touch costs in time, and how much of the population cannot wait. That produces a capacity figure specific to the practice, and it can be checked against reality next period.

Almost certainly that arrivals are exceeding clearance, which makes it a structural problem rather than an effort problem. Overtime raises clearance temporarily and does nothing to arrivals, so the queue resumes growing when the overtime stops — and the hours tend to be spent at the oldest, least recoverable end of the population. The productive responses are upstream: reduce what arrives, by fixing payer-level causes and by not generating touches on claims that are progressing normally, and reduce what each arrival costs, by establishing state through a transaction rather than a call. Sizing the team is the step after those, not instead of them.

Only if something changed. Counting touches rewards activity and hides the failure mode that matters, which is a queue being worked diligently and clearing nothing. Clearance is better counted by accounts leaving the population, separated by how they left — resolution means the process worked, and write-off means it ran out of options or out of time. Combining those produces a clearance figure that improves as the practice loses money, which is worse than having no figure at all.

Not entirely, and the distinction matters for a capacity model. Under 45 CFR 162.923(a), a covered entity conducting a transaction for which a standard has been adopted, electronically with another covered entity, must conduct it as a standard transaction; and under (b), a provider electing to use direct data entry offered by a plan must still meet the applicable data content and data condition requirements of the standard, being relieved only of its format requirements. So manual portal work is not a rules-free alternative and is not the natural baseline. A capacity model built on the assumption that this work is inherently manual is planning around a choice rather than a constraint.

It can supply capacity, and it does not supply accountability. 45 CFR 162.923(c) expressly permits a covered entity to use a business associate, including a clearinghouse, to conduct a transaction — and requires that the covered entity require the business associate to comply with all applicable requirements, and to require any agent or subcontractor to do the same. The practical consequence for the model is that bought capacity carries an oversight cost the practice bears itself, so a plan comparing in-house hours against a vendor without that cost is comparing the wrong two numbers. It is also why the decision belongs before placement rather than after it.