Your A/R Aging Report May Be Telling You More Than You Think
Every medical practice has accounts receivable, that’s normal. Patients receive care, claims are submitted, insurance companies process them, payments arrive, patient balances are collected – the problem begins when those accounts don’t move. A claim that remains unpaid for 30 days deserves attention and the one that reaches 60 days deserves more attention. But when your practice starts carrying a significant amount of 90+ day A/R, the issue is no longer simply that you’re waiting to get paid.
Your revenue cycle may be slowing down.
And the longer an account remains unresolved, the harder it can become to collect. The AMA identifies days in A/R as one of the most revealing indicators of financial health for physician practices. Its guidance suggests that practices should work toward collecting within approximately 30 days, while other industry guidance places a healthy target around 30–40 days.
So if your practice has a growing 90+ day bucket, the right question isn’t: “Why haven’t we collected this money yet?” The better question is: “Why did this account get this old in the first place?” That’s where effective A/R management begins.
What Is 90+ Day A/R?
A/R or accounts receivable represents money owed to your practice for services already provided. Your aging report typically divides those outstanding balances into categories such as:
- 0–30 days
- 31–60 days
- 61–90 days
- 91–120 days
- 120+ days
The 90+ day category is particularly important because these accounts have already moved well beyond the normal payment cycle for many clean claims. MGMA’s revenue-cycle guidance identifies less than 10% of A/R over 90 days as a useful benchmark, although appropriate targets can vary by specialty, payer mix, contractual arrangements and practice circumstances. The number itself matters, but the reason those accounts are aging matters even more.
Why 90+ Day A/R Is Dangerous
Aging A/R affects more than your accounting report, it can affect Cash flow – money that should have entered the practice remains tied up in unresolved accounts. Staffing – your team spends time repeatedly working old accounts rather than preventing new problems. Revenue predictability – the longer reimbursement takes, the harder it becomes to forecast cash flow. Write-offs and bad debt – older accounts can become increasingly difficult to recover. Administrative costs – every additional touch—phone call, portal inquiry, corrected claim, appeal or statement—has a cost. Practice growth – Cash tied up in A/R isn’t available for hiring, technology, expansion or other business priorities.
That’s why A/R should be viewed as an operational metric, not simply an accounting number.
7 Common Reasons Medical A/R Gets Stuck
There isn’t one universal cause of aged A/R, in most practices, it’s a combination of issues.
1. Claims Were Never Submitted Correctly
A claim may have:
- Incorrect payer information
- Incorrect patient demographics
- Missing information
- Incorrect provider details
- Coding errors
- Modifier problems
- Missing authorization
- Incorrect coordination of benefits
The claim may then be rejected or denied, and the balance begins aging. The longer the issue remains unidentified, the older the account becomes.
2. Denials Are Being Worked Too Slowly
A denial is not the end of the revenue cycle. It’s an opportunity to correct the problem and recover the payment. But a denial that sits untouched for weeks can quickly become a 60-, 90-, or 120-day account. This is particularly concerning because MGMA’s January 2026 revenue-cycle poll found that 48% of respondents identified denials and appeals as their biggest source of revenue-cycle leakage. The solution isn’t simply to hire someone to work more denials. You need to understand: Why are the denials happening? And are the same denial reasons occurring repeatedly?
3. Eligibility Problems Were Discovered Too Late
Eligibility is a front-end process, but its financial consequences often appear much later. An outdated insurance ID, an inactive policy, a coverage termination, a coordination-of-benefits issue, a patient who isn’t covered for a particular service. These problems can eventually become unpaid or denied claims. MGMA’s 2026 data identified front-end issues – including eligibility and benefits verification – as the second-largest source of revenue-cycle leakage after denials and appeals. That’s why good A/R management starts before the claim is ever submitted.
4. Prior Authorization Was Missing or Incorrect
A claim can be perfectly coded and submitted on time and still fail because the required authorization wasn’t obtained. Depending on the payer and service, authorization requirements may involve:
- Specific procedures
- Imaging
- Specialty medications
- Therapies
- Referrals
- Certain high-cost services
If authorization problems aren’t caught before service, the practice may end up trying to solve a problem after the fact. And by then, the claim is already aging.
5. The Claim Was Paid Incorrectly
Not every unpaid or underpaid account is a traditional denial. Sometimes the payer processes the claim – but the payment isn’t what the practice expected. That can happen because of:
- Contractual reimbursement differences
- Incorrect payer processing
- Bundling
- Modifier issues
- Downcoding
- Incorrect application of benefits
- Payer-specific edits
MGMA’s 2026 revenue-cycle reporting specifically highlights payer behavior, down coding and payer-policy implementation as sources of revenue leakage. If payment variance isn’t monitored, these issues can quietly accumulate.
6. The A/R Is Being Worked – But Not Prioritized
This is a surprisingly common problem. A billing team may be working hundreds of accounts every month but are they working the right accounts first? Consider two outstanding claims:
Claim A: $75, 105 days old
Claim B: $4,500, 105 days old
Both are aged but they shouldn’t necessarily receive identical priority. A good A/R strategy considers:
- Dollar value
- Age
- Payer
- Probability of collection
- Denial reason
- Timely filing limits
- Appeal deadlines
- Patient vs. insurance responsibility
A/R management isn’t simply about working more accounts. It’s about working the right accounts at the right time.
7. Nobody Is Looking at the Root Cause
This may be the biggest problem. Your team works a denied claim and it gets corrected. The payer eventually pays and Everyone moves on. Then the same denial appears 20 more times – that’s not ideal denial management.
That’s denial recycling. The same principle applies to A/R. If eligibility errors repeatedly create old claims, work on eligibility. If authorization problems create aged accounts, improve authorization workflows. If coding issues are driving denials, address the coding/documentation process. If one payer consistently delays reimbursement, analyze that payer separately. The goal isn’t just to reduce today’s A/R. It’s to prevent tomorrow’s A/R from becoming aged.
How to Reduce Your 90+ Day A/R
Here is a practical framework.
Step 1: Know Your Numbers
Start with your A/R aging report.
Measure:
- Total A/R
- 0–30 days
- 31–60 days
- 61–90 days
- 91–120 days
- 120+ days
- Percentage of A/R over 90 days
- Days in A/R
- Insurance A/R
- Patient A/R
Don’t stop at the total dollar amount – look for trends.
Step 2: Segment Your A/R
Break your aged A/R down by:
Payer – Which insurance companies account for the most aged balances?
Provider – Is one physician generating disproportionately aged claims?
Location – Does one office have more aging than another?
Service – Are certain procedures creating recurring issues?
Denial reason – Are specific denial codes appearing repeatedly?
Age – How much is 91–120 days versus 120+?
This turns a large, intimidating number into a set of manageable problems.
Step 3: Prioritize 90+ Day Accounts
Start with the oldest accounts – but don’t blindly work them in chronological order.
Prioritize based on:
High-dollar accounts – A $10,000 claim deserves immediate attention.
Timely filing or appeal deadlines – Don’t allow an actionable account to age into an unrecoverable one.
Recurring payer issues – Identify patterns that may require escalation.
Claims with clear resolution paths – Work accounts where a correction or appeal can realistically produce payment.
Patient balances – Create a separate workflow for patient A/R rather than treating it exactly like insurance A/R.
Step 4: Create Denial Categories
Don’t use one generic category called: “Denied” Create meaningful categories such as:
- Eligibility
- Authorization
- Medical necessity
- Coding
- Modifier
- Timely filing
- Coordination of benefits
- Credentialing
- Documentation
- Non-covered service
- Payer processing error
Then track the dollar value associated with each category. You may discover that your biggest problem isn’t your biggest number of denials. It may be the denial category producing the greatest financial loss.
Step 5: Establish an A/R Follow-Up Rhythm
A/R shouldn’t be something your team remembers to work when there is time, establish defined workflows.
For example:
Daily
- New rejections
- High-priority claim issues
- Time-sensitive accounts
Weekly
- 30+ day A/R review
- Denial trends
- Payer issues
- High-dollar accounts
Monthly
- Complete aging analysis
- 90+ day A/R review
- Root-cause analysis
- Payer performance
- Collection trends
AMA guidance similarly recommends that practices maintain visibility into A/R aging, claim timelines and denial trends when overseeing billing operations.
Step 6: Don’t Let New A/R Become Old A/R
This is critical. You cannot solve an A/R problem by only working yesterday’s problems. You need to prevent new accounts from aging.
Monitor:
- Charge lag
- Claim submission lag
- Clearinghouse rejections
- Eligibility errors
- Authorization failures
- Coding delays
- Unworked denials
- Unposted payments
A healthy revenue cycle is designed to keep claims moving.
Step 7: Measure the Results
At minimum, track:
| KPI | Why It Matters |
|---|---|
| Days in A/R | Shows how quickly revenue is being converted to cash |
| A/R >90 days | Shows how much revenue is becoming aged |
| Clean claim rate | Indicates front-end and billing accuracy |
| Denial rate | Identifies claims requiring additional work |
| Net collection rate | Shows how effectively collectible revenue is being captured |
| Charge lag | Measures how quickly services become charges |
| Claim lag | Measures how quickly charges become claims |
| Patient A/R | Tracks outstanding patient responsibility |
AAFP also identifies days in A/R, adjusted collection rate and denial rate as core revenue-cycle metrics for physician practices.
Don’t Manage A/R in Isolation
One of the most important lessons for practice leadership is that A/R is an outcome of multiple processes. If your A/R is high, don’t immediately conclude: “The billing team isn’t working hard enough.”
Ask:
Are charges being captured quickly?
Are claims being submitted correctly?
Are eligibility issues being caught before visits?
Are authorizations being obtained?
Are denials being categorized?
Are appeals being filed on time?
Are payer underpayments being identified?
Are patient balances being communicated clearly?
These questions take you from symptom management to root-cause management.
A Simple 90+ Day A/R Action Plan
If your practice discovers that its 90+ day A/R is higher than it should be, start here:
Week 1: Diagnose
Analyze the entire 90+ day A/R by:
- Payer
- Dollar value
- Denial reason
- Provider
- Age
- Patient vs. insurance responsibility
Week 2: Prioritize
Create three buckets:
Recover immediately – Accounts with a clear path to payment.
Escalate – High-dollar, complex or payer-related issues.
Evaluate – Accounts where collection may no longer be economically practical.
Week 3: Fix
Address recurring root causes:
- Eligibility
- Authorization
- Coding
- Claim submission
- Denial workflows
- Payer issues
- Patient collections
Week 4: Monitor
Compare:
- Total A/R
- 90+ day A/R
- Days in A/R
- Denial rate
- Net collections
Then repeat the process monthly.
The Goal Isn’t Zero A/R
It’s important to make one distinction. A medical practice will always have A/R. The objective isn’t to eliminate A/R. The objective is to ensure that:
Claims move quickly.
Problems are identified early.
Denials are worked promptly.
Payments are posted accurately.
Patient balances are managed appropriately.
Older accounts don’t become forgotten accounts.
In other words: Healthy A/R isn’t about having no outstanding money. It’s about having the right money outstanding for the right amount of time.
How AllegianceRCM Can Help
Managing A/R effectively requires more than repeatedly calling insurance companies. It requires visibility, prioritization, follow-up and root-cause analysis. AllegianceRCM can support practices across the revenue cycle, including:
- Claims management
- A/R follow-up
- Denial management
- Eligibility and benefits verification
- Prior authorization support
- Medical coding
- Payment posting
- Underpayment analysis
- Patient A/R support
- Credentialing and payer enrollment
- RCM reporting and KPI monitoring
Our objective is to help practices move from “We have a lot of old claims.” to “We know why our claims are aging, what we’re doing about them, and whether our revenue cycle is improving.”
Final Takeaway
If your practice has a growing 90+ day A/R balance, don’t wait for it to become a cash-flow crisis. Start by asking three questions: How much money is sitting in 90+ day A/R? Why is it there? What are we doing differently to prevent it from happening again The answers can reveal more about the health of your revenue cycle than the total collections number alone. Because getting paid isn’t just about submitting claims. It’s about keeping revenue moving.
Is Your A/R Telling You Something?
AllegianceRCM helps healthcare practices identify aging A/R, uncover revenue-cycle bottlenecks and build more effective billing, denial and collections workflows. Want to understand where your A/R is getting stuck?
Request a Revenue Cycle Health Check
This article is intended for general educational purposes and does not constitute legal, coding, reimbursement or compliance advice. RCM benchmarks can vary by specialty, payer mix, contract terms and practice structure.
