Finance & FP&A

How to track ar aging and run collections as Independent Clinic Owner-Operators

Finance & FP&AFor Independent Clinic Owner-Operators3 apps12 steps~24 min to set up

Your billing person spends Tuesday and Wednesday every week inside your practice management software — Jane, Kareo, or whatever you're running — exporting an AR aging report, pasting it into a spreadsheet, color-coding buckets by 30/60/90/120+ days, and manually drafting follow-up emails to insurance reps and patients. Denials that have been sitting 45 days get flagged only when she notices them. The 90-day bucket is where cash quietly disappears. You have no live view of which payers owe you what, and you find out your collections rate has slipped three weeks after it happened when the bank balance tells you something is off.

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Finance & FP&AFor Independent Clinic Owner-Operators3 apps12 steps~24 min to set up

Outcome

What you'll set up

A live AR aging dashboard that shows every outstanding balance bucketed by 30/60/90/120+ days, updated daily from your bank and accounting data — no spreadsheet exports, no waiting on your billing person to compile the report

Automated collections follow-up drafts: when a claim crosses 45 days unpaid, Starch drafts the follow-up email to the payer or patient and queues it for one-click send — nothing falls through the cracks between billing cycles

A weekly cash-in-projection that combines what's owed in AR with your actual burn rate, so you know whether next month's payroll is covered before it's a problem

The Starch recipe

Apps, data, and prompts

The combination of Starch apps, the data sources they pull from, and the prompts you use to drive them.

Apps used

Runway Analysis Transaction Insights Email Agent

Data sources & config

Starch connects directly to QuickBooks (scheduled sync — invoices, payments, vendors, and journal entries refresh on a schedule) and syncs your Plaid bank feed on a schedule for live balance and expense data. Gmail connects from Starch's integration catalog; the agent queries it live when drafting or sending collections follow-ups. Your EHR's patient-facing billing portal — Jane, Kareo, SimplePractice — is reachable through browser automation if it doesn't expose a direct API, so Starch can pull balance details or submit follow-ups through your browser with no API needed.

Prompts to copy

Build me an AR aging dashboard that shows outstanding balances from my QuickBooks invoices, bucketed by 0-30, 31-60, 61-90, and 90+ days. Flag any invoice that has been open more than 45 days and show me the payer name, original amount, and days outstanding.

Every Monday morning, look at my AR aging dashboard, find any invoice over 45 days unpaid, and draft a follow-up email to the payer. Queue the drafts in my inbox so I can review and send with one click. Also flag any new denials from the last 7 days.

Show me a 90-day cash projection that combines my expected AR collections from QuickBooks with my actual bank balance and current monthly expenses from Plaid. Tell me if there's a month where projected cash dips below two months of operating expenses.

Run these in Starch → or paste them into your favorite agent

Walkthrough

Step-by-step

1 Connect QuickBooks to Starch — Starch syncs your invoices, payments, bills, and vendor records on a schedule. This is the source of truth for what's owed and what's been paid.

2 Connect your Plaid bank account — Starch syncs transactions and balances daily so your cash position is always current alongside the AR picture.

3 Connect Gmail from Starch's integration catalog so the agent can draft and queue follow-up emails to payers and patients without leaving the workflow.

4 Open the Runway Analysis app (pre-built) and customize it: tell Starch 'use my QuickBooks AR balance as projected inflows, not just Stripe revenue, and show me 90-day cash runway.' Starch rebuilds the projection with your clinic's actual receivables mix.

5 Build the AR aging dashboard by typing your prompt into Starch. The agent pulls all open QuickBooks invoices, calculates days outstanding, and renders the 30/60/90/120+ buckets in a single view you can bookmark.

6 Set a weekly automation: 'Every Monday at 7am, check my AR aging. For every invoice over 45 days, draft a follow-up email using the payer's contact from QuickBooks, reference the invoice number and original date, and add the draft to my Gmail Drafts folder.'

7 Add a denial-flagging rule: 'If a QuickBooks invoice has been partially paid and the remaining balance has not changed in 30 days, treat it as a likely denial and include it in the Monday morning flag list with a note that the partial payment date was [date].'

8 For payers or patient portals that don't sync directly — like a state Medicaid portal or a clearinghouse web interface — describe the workflow and Starch automates it through your browser. No API required.

9 Wire the Transaction Insights app to catch anything the AR view misses: unexpected vendor charges, a billing service fee that doubled, or an autopay that shouldn't have hit this month. Starch flags anomalies automatically.

10 Set a second automation for patient-balance follow-ups: 'Every Thursday, find QuickBooks invoices marked as patient-responsibility that are more than 21 days unpaid and draft a short, friendly reminder email to send from my practice Gmail account.'

11 Review your dashboard every Monday before seeing your first patient — AR aging, cash projection, and a queue of follow-up drafts ready to send in under five minutes.

12 Once a month, ask Starch: 'Compare my collections rate this month versus the last three months. Which payer has the most dollars sitting in the 60+ day bucket?' Use that answer to decide where your billing person focuses her week.

See this running on Starch

Connect your tools, describe what you want, and the agent builds it. Closed beta is free.

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Worked example

March 2026 AR Review — 3-Provider Family Practice

Sample numbers from a real run

BlueCross claims, 0-30 days	18,400
Aetna claims, 31-60 days	7,200
Medicare claims, 61-90 days	4,100
Patient balances, 31-60 days	2,800
State Medicaid, 90+ days (likely denial)	3,300
Current bank balance (Plaid)	41,000

On Monday March 3, Starch's weekly automation ran at 7am. It pulled all open QuickBooks invoices and found $35,800 total in AR. The 90+ day bucket showed $3,300 from state Medicaid — same balance for 11 weeks, no payment activity. Starch flagged it as a likely denial and drafted a follow-up to the Medicaid provider relations line referencing invoice #MC-2024-1147 and the original submission date of December 10. The billing person reviewed the draft, added a prior authorization number from her notes, and sent it in 90 seconds. The 61-90 day Medicare bucket had $4,100 across six claims; Starch drafted individual follow-ups for each, queued in Gmail Drafts. The cash projection, combining the $41,000 bank balance with $18,400 in expected near-term BlueCross receipts and the clinic's $28,000 monthly burn (from Plaid), showed 2.1 months of runway — tight enough that the owner flagged it in the Monday standup and pushed the equipment purchase to April. Total time spent by the owner: 8 minutes.

Measurement

How you'll know it's working

Days in AR (average days from service date to payment received, tracked monthly per payer)

Collections rate by payer (percentage of billed charges actually collected, broken down by BlueCross, Aetna, Medicare, Medicaid, and patient-pay)

90+ day AR as a percentage of total AR (anything over 15% is a red flag for a small clinic)

Cash runway in months (bank balance plus expected AR inflows divided by monthly burn)

Follow-up response rate (percentage of 45-day follow-up emails that result in payment or denial notice within 14 days)

Comparison

What this replaces

The other ways teams handle this today, and how the Starch version compares.

QuickBooks AR aging report (built-in)

QuickBooks shows you the aging snapshot but won't draft follow-up emails, trigger automations on specific buckets, or combine AR with your live bank balance in a single projection — you still build that manually in a spreadsheet.

Kareo or Jane built-in billing reports

Strong for claim-level detail inside the EHR, but the data stays siloed — you can't combine it with your bank transactions, build a cash projection, or automate the follow-up drafts without exporting and switching tools.

Billing service / RCM vendor

Takes collections off your plate entirely but costs 5-8% of collections, gives you limited visibility into why things are aging, and doesn't help with the cash-projection or vendor-spend side of the business.

Excel or Google Sheets AR tracker

Free and flexible, but someone has to maintain it manually every week — the moment your billing person is out sick, the aging report is a week stale and the follow-ups don't happen.

On Starch RECOMMENDED

One platform — runway analysis, transaction insights, email agent all running on connected data. Setup in plain English; numbers stay current via scheduled syncs and live agent queries.

Try it on Starch →

FAQ

Frequently asked questions

My EHR is Jane (or Kareo, or SimplePractice) — can Starch connect to it directly?

Most EHRs don't offer a public API for AR data. Starch handles this through browser automation — it can navigate your EHR's web interface, pull the aging report, and feed that data into your dashboard, no API needed. For billing and payment data, QuickBooks is usually the cleaner path if your billing person posts payments there; Starch syncs QuickBooks on a schedule and uses that as the AR source of truth.

Does Starch actually send the follow-up emails, or just draft them?

Starch drafts the emails and queues them in Gmail for your review. You can configure it to send automatically, but for collections follow-ups to payers — where a wrong email can create a paper-trail problem — most clinic owners prefer the one-click-review step. The value is that the draft is already written and waiting at 7am Monday, not that you had to ask for it.

Will this replace my billing person?

No, and it's not trying to. Your billing person knows why a specific Aetna claim was denied and how to appeal it — Starch doesn't have that context. What Starch removes is the two hours she spends each week building the aging report manually and writing the same follow-up emails she's written a hundred times. She focuses on the actual billing decisions; Starch handles the repetitive tracking and drafting.

Is my patient billing data secure? Are you HIPAA compliant?

Starch is not SOC 2 Type II certified today (that's on the roadmap). For workflows that touch patient-identifiable billing data, check with your privacy officer before connecting a system that processes PHI. Many clinic owners scope the Starch AR workflow to the payer side — claim amounts and payer names from QuickBooks, which doesn't carry clinical data — and keep patient-specific balance detail inside the EHR.

My QuickBooks report views (P&L, Transaction List) aren't loading — is that a Starch problem?

QuickBooks' report-view endpoints are temporarily disabled in Starch's connector pending an upstream fix. Entity-level data — invoices, bills, payments, vendors, journal entries — syncs normally. Your AR aging dashboard pulls from invoice and payment entities directly, so it works fine. The P&L view inside QuickBooks won't sync until that fix ships; use the Transaction Insights app with your Plaid bank feed for expense tracking in the meantime.

How is this different from just running the AR aging report in QuickBooks every Monday?

Three differences: first, Starch combines the AR picture with your live bank balance and burn rate so you see cash runway, not just what's owed. Second, the follow-up emails are drafted automatically — you're reviewing a queue, not writing from scratch. Third, the 45-day and 90-day flags trigger without you having to remember to look; the automation runs whether or not you open the report.