30-60-90 day plan for medical billers
On this page
- What does a medical biller own that a coder or practice manager does not?
- What does the 30-60-90 day plan look like?
- Which deadlines and rules does a medical biller work to?
- Which work queues does a new medical biller take over?
- Which numbers should a new medical biller baseline?
- What does "on track" look like at day 30, 60 and 90?
- A filled example
- How should the hiring manager use this plan in the final interview?
- What should the billing manager ask at the check-ins?
- What the billing manager owes a new medical biller
- Common mistakes
- Adapting the plan
- Questions people ask
A 30-60-90 day plan for a new medical biller should learn the practice's payers, their filing limits and every billing work queue in the first 30 days; own claim follow-up, denials and appeals for a set of payers in days 31-60; and by day 90 run those payers without missed deadlines, with the top denial reasons worked at their cause and old credit balances resolved. The biller's calendar is set by rules, not habits: as of November 2026, Medicare claims must be filed within one calendar year of the date of service, first-level Medicare appeals within 120 days of the decision, and identified Medicare overpayments returned within 60 days.
This page is for the billing manager, revenue cycle lead or practice manager hiring a medical biller, billing specialist or accounts receivable specialist for physician or clinic billing. The practice-wide view, including payer enrollment, exclusion checks and good faith estimates, is in the 30-60-90 day plan for medical practice managers; HIPAA, OSHA and CLIA records are in the 30-60-90 day plan for clinic managers. If the seat is still open, the medical biller and coder job description template sets out the credentials and the overtime classification.
What does a medical biller own that a coder or practice manager does not?
| Area | Medical biller | Medical coder | Practice manager |
|---|---|---|---|
| Claims | Submits claims, fixes clearinghouse rejections, follows up on unpaid claims | Assigns diagnosis and procedure codes from the record | Owns the revenue cycle and its reporting |
| Payments | Posts or reconciles remittances, works payment exceptions, finds underpayments | Not usually involved | Owns payer contracts and fee schedules |
| Denials and appeals | Works denials by reason, files corrected claims and appeals inside the deadlines | Reviews coding denials and supports appeals | Fixes denial causes that start in scheduling or enrollment |
| Patient balances | Sends statements, answers billing questions, sets up payment plans under policy | None | Sets financial and collection policy |
| Credit balances | Researches them and processes refunds or offsets | None | Approves refunds over a set amount |
Small practices often combine billing and coding in one seat. If they do, add the coding goals to month one and get the coder's work reviewed by a credentialed coder before claims go out.
What does the 30-60-90 day plan look like?
30-60-90 day plan — [Name], Medical Biller, [practice / billing team]
Reports to: [billing manager / practice manager] Start date: [date]
Specialty: [ ] Providers: [N] Claims per month: [N]
Systems: [practice management / EHR, clearinghouse, payer portals]
Payers assigned: [Medicare, Medicaid plan, commercial payers]
DAYS 1-30 — Learn the payers and the queues
Goals:
- Build a payer grid: timely filing limit, appeal limit, portal,
prior authorization rules and contact for each assigned payer
- Shadow every queue: charge holds, clearinghouse rejections,
denials, payment posting exceptions, credit balances,
patient balances and payer correspondence
- Read the last [3] months of denials by reason and payer
- Work [example: 50] claims and [example: 25] denials with a
senior biller reviewing each one
- Learn the HIPAA rules for billing calls and payer portals
Deliverables by day 30:
- Payer grid agreed with the billing manager
- Queue map: each queue, what lands there, who works it, how fast
DAYS 31-60 — Own a set of payers
Goals:
- Own follow-up, denials and appeals for [assigned payers]
- Work claims by deadline first, then by dollar amount
- Track every appeal: date filed, deadline, level, outcome
- List credit balances older than [example: 60] days with cause
- Log denial causes that start before billing (eligibility,
authorization, registration, coding) and route them
Deliverables by day 60:
- Appeals log with no missed deadlines
- Denial cause log shared with the front desk and coding leads
DAYS 61-90 — Fix causes, not only claims
Goals:
- Agree one fix for the top denial reason with its owner
(example: an eligibility check two days before the visit)
- Clear or explain every aged credit balance on the list
- Prepare for the next code set update (see the calendar below)
- Cross-train a backup on the assigned payers
Deliverables by day 90:
- One denial reason reduced, measured against the day-60 log
- Credit balance list closed or explained, with refunds approved
Check-ins: weekly with [billing manager]; reviews at day 30, 60 and 90.Numbers in brackets are examples; size them to the practice's claim volume.
Which deadlines and rules does a medical biller work to?
The federal rules below are stated as of November 2026 and summarize the sources linked. Commercial payers, Medicaid plans and Medicare Advantage plans set their own filing and appeal limits in their contracts and manuals, so the payer grid needs each one. This is not legal advice.
| Item | What applies | Source |
|---|---|---|
| Medicare timely filing | For services on or after January 1, 2010, the claim must be filed no later than one calendar year after the date of service; narrow exceptions are listed in the regulation | 42 CFR 424.44 |
| Medicare redetermination (first appeal level) | Filed within 120 calendar days of receiving the initial determination; receipt is presumed five calendar days after the notice date | 42 CFR 405.942 |
| Medicare reconsideration (second level) | Filed with the qualified independent contractor within 180 calendar days of receiving the redetermination | 42 CFR 405.962 |
| Medicare and Medicaid overpayments | Reported and returned by the later of 60 days after the overpayment is identified or the cost report due date; identified means the person knowingly receives or retains it; the deadline is suspended during a timely, good-faith investigation of related overpayments | 42 CFR 401.305 |
| Uninsured and self-pay bills above the good faith estimate | A patient billed at least $400 more than a provider's good faith estimate can start patient-provider dispute resolution within 120 calendar days of receiving the first bill | 45 CFR 149.620 |
| Coding edits | CMS updates the NCCI procedure-to-procedure and medically unlikely edit files quarterly | CMS NCCI edits |
| Diagnosis codes | New ICD-10-CM codes took effect October 1, 2026, for encounters through September 30, 2027; CMS has also posted April 1 updates in recent years | CMS ICD-10 page |
| Privacy on billing work | Uses and disclosures of protected health information for payment are limited to the minimum necessary for the purpose | 45 CFR 164.502(b) |
Two practical points follow. First, a Medicare appeal deadline runs from receipt of the notice, presumed five days after its date, not from the day the denial reaches the biller's queue, so remittances that sit unposted eat into the window. Second, an old credit balance is not just an accounting tidy-up: when it is a Medicare or Medicaid overpayment, the 60-day clock in 42 CFR 401.305 applies once it is identified. Commercial refunds follow the payer contract and state law.
Which work queues does a new medical biller take over?
| Queue | What lands there | What to check in month one |
|---|---|---|
| Charge holds | Visits with missing codes, documentation or registration data | How long charges sit, and which providers or fields cause holds |
| Clearinghouse rejections | Claims that never reached the payer because of format or data errors | Rejections are not denials; they must be fixed and resent before the filing limit |
| Denials | Claims the payer processed and refused, with claim adjustment reason codes on the remittance | Top reasons by payer and whether each starts before or after the visit |
| Payment posting exceptions | Remittances that did not post automatically, underpayments against the fee schedule | Whether contracted rates are loaded and checked |
| Credit balances | Accounts where payments exceed charges | Age, cause and whether any are Medicare or Medicaid overpayments |
| Patient balances | Statements, payment plans, questions and disputes | Statement cycle, payment plan policy, who approves adjustments |
The X12 code list describes claim adjustment reason codes as the reason "a claim or service line was paid differently than it was billed" (X12 claim adjustment reason codes). Grouping denials by those codes and by payer is how the day-60 cause log gets built.
Which numbers should a new medical biller baseline?
The measures are examples. Use the billing system's own reports, define each measure the same way every month, and set targets only after the day-60 baseline.
| Measure (examples only) | What it shows |
|---|---|
| Claims accepted by the payer on first submission, for the assigned payers | Data quality before the claim leaves |
| Denials by reason and payer, and the share that start before the visit | Which fixes belong to the front desk, coding or billing |
| Days from denial received to denial worked | Whether the queue keeps up with appeal windows |
| Claims written off for missed filing or appeal limits | Revenue lost to the calendar, which should be close to none |
| Accounts receivable over 90 days for the assigned payers | Where follow-up has stalled |
| Credit balances older than the practice's limit, by cause | Refunds and overpayments waiting |
| Appeals filed and overturned, by reason | Which appeals are worth the time |
What does "on track" look like at day 30, 60 and 90?
| Checkpoint | On track | Worth a direct conversation |
|---|---|---|
| Day 30 | Payer grid complete with sources; can explain each queue; reviewed work shows few repeat errors | Works claims by date received with no view of deadlines; filing limits quoted from memory |
| Day 60 | Owns the assigned payers; every appeal logged with its deadline; denial causes routed to their owners | Appeals tracked in email; the same denial resubmitted unchanged |
| Day 90 | One denial reason measurably down; aged credit balances resolved or explained; a trained backup | Write-offs for missed limits; credit balances growing |
A filled example
Medical biller: Marisol Ortega (invented), joining the in-house billing team of an orthopedic group with eight providers, reporting to the billing manager. Assigned payers: Medicare and two commercial plans. All details are examples.
Day 30: The payer grid showed one commercial plan with a much shorter filing limit than the others, and its claims sat in the same queue as everyone else's. Denials for that plan were mostly for missing prior authorization on imaging. A batch of remittances had sat unposted for two weeks.
Day 60: She worked claims for the short-limit plan first and logged every appeal with its deadline. The denial cause log showed most authorization denials started at scheduling, so she took the list to the front desk lead. She listed 40 credit balances older than 60 days; several were Medicare overpayments from duplicate payments.
Day 90: The front desk added an authorization check when imaging is scheduled, and authorization denials fell over the next month. The Medicare overpayments were reported and returned with the billing manager's approval, and the rest of the list was refunded or explained. A second biller was trained on her payers.
How should the hiring manager use this plan in the final interview?
Give every finalist the same brief: the specialty, the payer mix, the systems and a short, de-identified sample of a denial report. Score the plans with the rubric in how to evaluate a 30-60-90 day plan in an interview. A strong biller plan starts from deadlines and causes, not from working the oldest claim first. Questions that test it:
- "You find a Medicare payment posted twice on one account. What happens next, and by when?"
- "A payer denies the same procedure for the third time this month. What do you do besides appeal?"
- "How do you decide which of 200 open claims to work today?"
- "A patient calls about a bill much higher than the estimate they were given. Walk me through the call."
The medical billing and coding screening questions cover the credentials and the denial experience to check earlier in the process. Never ask a candidate to bring real patient data to the interview; use a de-identified sample.
What should the billing manager ask at the check-ins?
- Day 30: Which payer's deadline is easiest to miss? Which queue has the oldest work in it?
- Day 60: What are the top three denial reasons for your payers, and where does each start? Which appeals are due in the next two weeks?
- Day 90: What did the denial fix change? Which credit balances are left, and why?
What the billing manager owes a new medical biller
- Access to the practice management system, clearinghouse and payer portals before day one, with credentials issued to the biller rather than shared.
- The payer contracts or fee schedules for the assigned payers, so underpayments can be spotted.
- Written policy for adjustments, write-offs, payment plans and refunds, with approval limits.
- A named senior biller or coder to review work in the first month, and a way to raise denial causes with the front desk and providers.
Common mistakes
- Working claims oldest first. Deadlines and dollar amounts decide priority; age alone misses the payer with the short limit.
- Treating rejections as denials. A rejected claim never reached the payer, and the filing clock keeps running.
- Appealing without fixing the cause. The same denial returns next month.
- Leaving credit balances for year end. A Medicare overpayment has a 60-day clock once it is identified.
- Shared portal logins. They break access controls and make it impossible to see who did what.
Adapting the plan
- Billing companies: each client practice is its own payer grid and queue map, and the billing company usually works under a business associate agreement; add each client's approval rules for write-offs and refunds to month one.
- Hospital or facility billing: institutional claims, longer payer manuals and more departments feeding charges; extend the shadowing in month one and add the charge capture owners to the cause log.
- Practices with many self-pay patients: weight month two toward estimates, statements and payment plans, and coordinate with the practice manager on the good faith estimate workflow.
- Dental offices: the claims and payers differ; the 30-60-90 day plan for dental office managers covers the schedule and claims baselines there.
The credential to look for is AAPC's Certified Professional Biller; as of November 2026, AAPC says it is kept current with annual membership and 36 continuing education units every two years.
Questions people ask
What should a new medical biller do in the first 30 days?
Learn the practice's main payers and their timely filing limits, shadow each work queue (charge holds, clearinghouse rejections, denials, payment posting exceptions, credit balances and patient balances), read the last few months of denial reports by reason, and work a set of claims and denials with a senior biller reviewing. The month ends with a payer grid and a queue map the billing manager agrees with.
What is the Medicare timely filing limit?
Under 42 CFR 424.44, as of November 2026, a Medicare claim for services furnished on or after January 1, 2010 must be filed no later than one calendar year after the date of service, with narrow exceptions listed in the regulation. Commercial and Medicaid limits differ by payer and contract, so a biller needs each payer's limit in writing.
How long does a provider have to appeal a Medicare claim denial?
A request for redetermination, the first level of a Medicare Part A or B appeal, must be filed within 120 calendar days of receiving the initial determination under 42 CFR 405.942, with receipt presumed five days after the notice date. The second level, reconsideration by a qualified independent contractor, must be filed within 180 days of receiving the redetermination under 42 CFR 405.962.
Which certification fits a medical biller?
AAPC's Certified Professional Biller (CPB) is built for billers: as of November 2026, AAPC says it covers the revenue cycle, payer rules, denials and appeals, and compliance, and it is kept current with annual AAPC membership and 36 continuing education units every two years. Many billers also hold a coding credential, but how a candidate has worked denials and appeals tells you more.