Healthy A/R days for an outpatient practice sit between 28 and 35. Above 40, you're financing the payer. Above 50, you're financing them at a discount, because every day past timely-filing risk is a day closer to writing it off entirely.
When a client calls and says "our A/R has crept past 40," we don't ask why. We ask three questions. The answers tell us exactly where the money is hiding.
Question 1: What's your aging mix?
Pull your aging report broken down by 0–30, 31–60, 61–90, 91–120, 120+. A healthy mix has roughly 65% in 0–30, 18% in 31–60, 9% in 61–90, 5% in 91–120, and the rest in 120+.
If your 91–120 bucket is over 8%, you have a follow-up problem. Someone is letting claims sit. If your 120+ bucket is over 6%, you have a write-off discipline problem — claims that should have been worked or written off are just lingering, inflating the report.
Question 2: What's the bucket by payer?
Same aging report, but grouped by payer. Then divide each payer's total A/R by their monthly billed amount. That's their days-in-A/R for you specifically.
Medicare should clear in 14–18 days. Big commercials should clear in 21–28. If a payer is sitting at 45+ and you're not in active appeals with them, something is broken in either submission or follow-up. We've seen cases where a single corrupted EDI loop was causing 3 weeks of silent rejections — the practice didn't know because the rejections weren't generating denials, just disappearing.
Question 3: What's your follow-up cadence?
Most practices don't have one. They have "Janet works the report when she has time." That's not a cadence; it's a hope.
Working cadence we recommend: any unpaid claim past day 25 gets a status check. Past day 35, it gets a documented payer call. Past day 50, it goes to an appeals or escalation queue with a supervisor. Past day 70, it gets a write-off recommendation that requires a manager sign-off.
The 14-day cure
We call it that because most clients see real movement in the aging report within two weeks of doing four things — not 90 days, two weeks. It's not magic. It's just doing the boring work consistently:
- 1Pick the top 3 payers by aged dollars. Ignore the others for the first two weeks.
- 2Assign one person, by name, to work each payer's 60+ bucket.
- 3Daily 15-minute standup: how many claims worked, what payer reps said, what's blocked.
- 4Re-run the aging report every Friday and look at the 60+ bucket. That number going down is the only metric that matters for the first two weeks.
We've never seen this fail to move the needle. The 60+ bucket usually drops 15–25% in the first 14 days. The total A/R days follow within 30. The hardest part isn't the work — it's protecting those four hours of focus from everything else that wants to interrupt them.