Case Study

An AR aging report is a snapshot of outstanding accounts receivable, grouped by how long balances have been outstanding. For ambulatory and physician practices, billed AR is commonly organized into 0-30, 31-60, 61-90, 91-120, and 120+ day buckets, though the exact aging basis can vary by reporting system. It’s typically generated from the practice management or billing system and reviewed regularly to identify balances that are becoming increasingly difficult or time-sensitive to resolve. Reading it well means looking past the total dollar figure and into which buckets, which payers, and which balance type, insurance or patient, are actually driving the number. What an AR Aging Report Actually Contains A standard AR aging report organizes outstanding balances into a few consistent elements. Time buckets group each balance by how long it has been outstanding, using the aging method defined by the reporting system, most commonly 0-30, 31-60, 61-90, 91-120, and 120+ days. Claim-level detail typically includes the date of service, billed amount, a claim identifier, and current status. Balances are often separated into insurance. AR, representing amounts owed by payers, and patient AR, representing amounts owed by patients or guarantors, since these two categories behave differently and usually need separate handling. The report totals each bucket, both overall and often broken down further by payer or provider, which is what turns a long list of individual balances into something a billing team can actually act on. Why Insurance AR and Patient AR Need to Be Read Separately Lumping insurance and patient balances into one aging total can hide real problems. Insurance AR is driven by payer processing timelines, denials, and pending claims, and it typically follows structured resolution paths like status checks, appeals, or corrected claims. Patient AR behaves differently: balances can be affected by statement timing, patient communication, deductibles, coinsurance, copays, payment plans, and other collection factors. Older patient balances may also become more difficult to collect, depending on the patient’s circumstances and the practice’s collection process. A practice with a healthy overall AR number can still have a real problem hiding underneath if one side, insurance or patient, is aging badly while the other looks fine and pulls the blended average down. Reading the Buckets: What Each One Signals The buckets aren’t just a way to sort balances by age. Each one can signal something different about what’s happening in the revenue cycle. 0-30 days is generally normal. But many claims in this range may still be in the applicable payer’s normal processing window and may not need to be actively taken action on yet unless they are rejected, have an unusual status, or have some other exception. 31-60 days: It’s the time to start checking the claim status directly, as this will confirm that the claim was actually received by the payer and allow you to monitor for denials, requests for documentation, and any other payer-related issues that you may need to address. 61-90 days are days in which a closer look should be paid. A balance logged here can mean a denial, missing information, a delay in payment processing, or some other issue hasn’t been addressed, and payment deadlines for timely filing, reconsideration, or payment appeals may be more pertinent to the payer. 90+ days, it gets more serious. The time remaining until the applicable payer filing, reconsideration, or appeal deadlines may be less for older balances based on the claim and payer rules. Failure to comply with an applicable deadline may mean that payment and/or appeals are restricted or become impossible, as well as possibly result in write-off, depending on the rules and exception possibilities of the payee. Signals Worth Watching Beyond the Raw Totals There are a couple of trends in an aging report that are worth highlighting, no matter how the numbers look. A 90+ month-over-month bucket may signal that follow-up or claim resolution is not tracking aging balances and should be investigated. If the aged balances are heavily skewed towards one of the payers, this can indicate issues with processing, documentation, authorizing, or denial at the payer level and should be investigated. And a high write-off rate combined with limited evidence of prior follow-up may warrant a review of whether balances are being worked consistently before they’re written off. Benchmarking Against Something Real An aging report is most useful when it’s measured against a target, not just reviewed in isolation. AR aging is most valuable when compared with relevant benchmarks and a practice’s own historical performance. HFMA publishes revenue-cycle KPIs that include aged AR as a performance indicator, while MGMA provides AR aging and days-in-AR benchmarks by practice characteristics, tracking AR across the same 0-30, 31-60, 61-90, 91-120, and 120+ day buckets, and recommends regular tracking and analysis of these metrics. Comparing a practice’s own bucket distribution against relevant peer benchmarks tends to be more useful than measuring against an arbitrary internal standard. A Quick Reference Checklist What to Check What It Signals Insurance vs. patient AR split Whether the blended total is masking a problem on one side 90+ day bucket trend Whether older balances are accumulating and warrant investigation Payer concentration in aged buckets Whether a disproportionate share of older AR is associated with one payer Write-off rate relative to follow-up activity Whether write-offs are occurring without sufficient prior collection activity Overall AR against relevant benchmarks How the practice’s AR aging and days in AR compare with appropriate HFMA or MGMA benchmarks Conclusion Reading an AR aging report is only useful if it leads to action on the right balances at the right time. Rapid RCM Solutions supports this through its AR and denial management and reporting services, helping practices interpret their aging data and follow up on the balances that actually need it before older balances become more difficult or time-sensitive to resolve.  FAQs