Accounts receivable is the money a practice has earned and not yet collected. Aging is how long each piece of it has been outstanding, grouped into buckets — typically 0–30, 31–60, 61–90, 91–120 and 120+ days.
The buckets are not just a reporting convention. They are a rough map of recoverability, and the relationship is not linear. A claim in the 0–30 bucket is usually just working its way through adjudication. A claim in the 120+ bucket usually has something wrong with it that nobody has addressed, and it may be approaching or past a filing or appeal deadline.
Total A/R is the least useful number on the report
It moves with volume. A practice that grows 30% will see A/R grow, and that tells you nothing about performance. The informative measures are compositional:
Days in A/R
How long, on average, revenue takes to convert to cash. Calculated as total A/R divided by average daily charges. MGMA data as summarised by industry analysts commonly places good physician-practice performance under 40 days, with medians varying meaningfully by specialty. Treat that as orientation, not as a target we're promising you'll hit.
Percentage of A/R over 90 days
The single most diagnostic number on the report. This is the share of receivables sitting in the zone where recovery odds decline sharply. A rising 90+ percentage while total A/R stays flat means claims aren't being worked — they're accumulating quietly behind a stable headline figure.
A/R by payer
Concentration is informative. If one payer holds a disproportionate share of your aged balance, you have a payer-specific process problem — an enrolment issue, a recurring denial, a submission requirement being missed — not a general A/R problem. It's also a much more tractable thing to fix.
Denied balance within A/R
How much of the outstanding balance is unpaid because it was actively refused, versus simply pending. These require completely different work, and mixing them together produces follow-up activity that accomplishes nothing.
Net collection rate
Of what you were contractually entitled to collect after allowable adjustments, how much did you actually collect. Commonly cited strong performance sits above 95%. This is the measure that captures revenue permanently lost to write-offs, missed appeals and expired filing windows.
Why aged claims stop being recoverable
Several clocks run simultaneously, and none of them wait for you:
- Timely filing. Payers set deadlines for initial claim submission. Past that, the claim is generally unpayable regardless of merit.
- Appeal windows. Denied claims have a limited period in which an appeal will be accepted. It is often shorter than the filing window.
- Corrected claim windows. Some payers limit how long after adjudication a corrected claim can be submitted.
- Documentation decay. Records get harder to assemble, the staff who remember the encounter move on, and the payer representative who made a verbal commitment is no longer reachable.
- Patient collectability. Balances that reach patients months after the visit are markedly harder to collect than balances discussed at the time.
Working an aging report in a sensible order
The instinct is to start at the top of the list and go down. That is close to the worst possible sequence. A better order:
- Deadline first. Anything approaching a filing or appeal cutoff, regardless of value. These are the claims that stop existing if you don't touch them this week.
- Then value within the 60–90 window. Still recoverable, still fresh enough to work efficiently, big enough to matter.
- Then payer concentrations. Grouping by payer means one call or one portal session can resolve several claims, and it surfaces the systemic cause.
- Then denial categories. Working ten claims with the same reason code together is far faster than working them scattered across a list.
- Then the long tail. Low-value aged claims get a defined amount of effort and then a documented decision.
That last point matters. Part of working A/R properly is deciding, deliberately and on the record, that a claim isn't worth further pursuit. What you want to avoid is that decision being made by default, through inaction, on claims that were actually worth chasing.
Underpayments hide in plain sight
A claim paid at less than the contracted rate shows as closed. It will not appear on an aging report. It is money missing from your net collection rate that nothing in your workflow is looking for.
Catching these requires comparing remittance against expected reimbursement at posting time, which is one of the more direct arguments for treating payment posting as analytical work rather than data entry.
What a healthy A/R operation looks like
- Aging is reviewed on a fixed schedule, not when someone notices cash is tight
- Claims are worked by deadline and value, not by list order
- Every follow-up is documented with date, contact and outcome
- The 90+ percentage is tracked as a trend, not just a snapshot
- Write-offs are decisions with reasons, not the residue of inattention
- Recurring causes get referred upstream instead of being reworked forever
If your A/R has built up during a staffing gap, a system change or a period of growth, the first useful step is not more follow-up activity — it's an honest assessment of what's still recoverable. Effort spent on claims that were never going to pay is effort not spent on claims that would have.
General information about US healthcare revenue cycle management. Benchmark figures describe the industry generally and are not representations about results for any Sure Rev Solution client. Sure Rev Solution does not guarantee collection rates or specific financial outcomes.