The Escalation Ladder That Stops 90+ From Stalling
Many teams do not struggle with 90 plus because they are not working. They struggle because escalation is not consistent.
In one team, a rep escalates fast. In another team, someone waits too long. One person knows the right payer contact and the right steps. Another person has to figure it out again from zero. The same account gets touched many times, but nothing changes.
This is not a effort problem. It is a workflow problem.
When escalation depends on the person, 90 plus becomes slow and unpredictable. Accounts get stuck. Notes get messy. Ownership becomes unclear. Time is wasted reading the same history again and again. That time loss often becomes revenue loss.
A simple escalation ladder fixes this. It is not a big policy document. It is a clear path the team follows when an account is stuck.
Why more follow up does not fix stuck accounts
Most 90 plus accounts are not ignored. They are worked many times.
The problem is that many touches do not always create progress. If the next step is unclear, people hesitate. If the next step needs a decision, people wait. The account stays in the same loop, and the backlog keeps growing.
What an escalation ladder is
An escalation ladder is a shared standard for the whole team. It answers four simple questions.
When do we escalate
Who owns the escalation step
What must be included before we escalate
Where do we record the decision and next action
When everyone follows the same ladder, the work becomes stable. The account does not depend on who is handling it.
The main reason escalations fail
Most escalations fail because the request is not complete.
The payer asks again for the same details. Or an internal team sends it back because something is missing. That creates more delays and more rework.
This is why a simple escalation packet helps. It should be short and clear. It should include
A one sentence problem statement
A short timeline of what happened
What has already been tried
What you need next from the payer or internal team
The deadline that matters
When this is consistent, escalation becomes faster and more successful.
A simple ladder most teams can use
You do not need many levels. Four levels is enough for most teams.
Level 1 is within AR
This is normal follow up using the standard payer steps and clear next action.
Level 2 is cross team
This is when AR needs something from another team such as coding, medical records, authorizations, or provider signature. Ownership and turnaround time must be clear.
Level 3 is formal payer escalation
This is when normal follow up does not work. This might be an appeal, a supervisor route, or a payer rep path. The steps should be documented so it is repeatable.
Level 4 is leadership decision
Some accounts need a business decision, not more follow up. This could be contract review, negotiation, settlement, compliance review, or write off decision. The decision must be recorded clearly so the account does not drift.
Why this improves trust, accuracy, and audit readiness
When escalation is inconsistent, records become hard to trust. Notes are different for every person. Decisions are not clear. People restart the work when the account changes hands.
When escalation is consistent, the record is clearer. The account history shows what happened, what was tried, what decision was made, and what happens next. Leaders get better visibility. Teams spend less time rechecking old notes. Audit review becomes easier because the process is steady and repeatable.
How to start without adding more stress
Start small.
Pick the top few issues that create the most repeated work. Define triggers and owners for each one. Use one simple escalation packet template. Review results weekly and improve the ladder over time.
The goal is not to add more work. The goal is to remove repeated work that does not move accounts forward.
How to start without adding more stress
Start small.
Pick the top few issues that create the most repeated work. Define triggers and owners for each one. Use one simple escalation packet template. Review results weekly and improve the ladder over time.
The goal is not to add more work. The goal is to remove repeated work that does not move accounts forward.
The long term result
Aged AR will always need follow up. But it should not rely on hero work.
When escalation follows a clear ladder, 90 plus stops stalling. Accounts move with fewer delays. The backlog becomes easier to control. And over time, fewer new accounts reach 90 plus because the team learns from patterns and fixes the root causes.
Zybex helps teams build this kind of structure so escalation is clear, ownership is visible, and progress is steady.