How to Reduce A/R Over 90 Days and Improve Medical Practice Cash Flow

A/R aging is a diagnostic signal

An increase in A/R over 90 days usually points to a process problem somewhere upstream.

For example, the practice may be submitting claims promptly but failing to follow up after payer responses. Another practice may have strong follow-up but recurring eligibility or authorization problems. A third may be posting payments slowly, making the aging report look worse than the actual payer activity.

This is why owners should not evaluate an aging report only by total dollars.

They need to know:

Which payer owes the balance? Why is it still open? When was it last worked? What is the next action? Is there a filing or appeal deadline? Who owns it?

Without those answers, A/R becomes a historical report instead of a management tool.

Old A/R also creates deadline risk

Payers have their own timely-filing and appeal requirements.

For Medicare fee-for-service claims, CMS generally requires claims to be submitted no later than one calendar year after the date of service, subject to limited exceptions. Other payer and plan requirements can differ, so practices need to track the deadlines that apply to their own contracts.

A 90-day-old claim may still be recoverable, but it should not remain untouched until the deadline becomes urgent.

Claims were never cleanly submitted

Some balances begin aging before the payer has even adjudicated the claim.

Incorrect patient information, missing authorization details, invalid provider information, wrong payer IDs, coding problems, or clearinghouse rejections may prevent a claim from moving normally through the billing cycle.

Rejected claims should be corrected quickly because the payer may not consider them successfully received.

MBT’s EMR/EHR and clearinghouse support includes enrollment management, claims-routing optimization, ERA/EFT setup, and denial-management workflows designed to strengthen visibility across the billing pipeline.

Denials are being worked too slowly

A denial should enter a structured workflow as soon as it is received.

The team should know the denial reason, payer, balance, supporting information required, filing or appeal deadline, previous action, next action, and responsible owner.

When that information is not organized, denials may be touched repeatedly without moving toward resolution.

MGMA guidance recommends working denials promptly and using aging reports to identify unresolved balances rather than allowing denied claims to remain unattended.

For more detail, MBT’s guide on reducing claim denials and payment delays explains how claim validation, denial management, A/R tracking, and payer follow-up connect.

Payment posting is incomplete or delayed

Not every old balance is truly unpaid.

A payment may have arrived but not been posted correctly. An adjustment may be missing. Patient responsibility may not have been transferred. An ERA may not have matched the correct account.

When posting falls behind, owners lose confidence in both the aging report and the cash-flow picture.

MBT’s medical billing services specifically include payment posting and A/R management, alongside claims management and denial follow-up.

Underpayments remain unresolved

Some claims are technically “paid” but still leave an unexpected balance.

Contractual reimbursement may not match the payment received, or a payer may apply an adjustment the practice does not expect.

Those balances should not remain in A/R indefinitely without review.

The billing team needs to determine whether the difference is contractual, collectible from another responsible party, appealable, or appropriate for adjustment.

Provider enrollment or credentialing is incomplete

Credentialing should not dominate an A/R strategy, but it can become an important root cause when claims repeatedly fail for one provider, location, or payer.

A provider who is not correctly enrolled or associated with a payer may generate claims that require additional investigation or correction.

MBT’s credentialing and provider-enrollment services include Medicare, Medicaid, and commercial payer enrollment, CAQH management, application tracking, and recredentialing.

No one clearly owns the balance

One of the simplest causes of aging A/R is unclear responsibility.

If every employee can see the claim but no one owns the next action, follow-up becomes inconsistent.

An A/R report should therefore operate as a work queue, not just a spreadsheet.

Segment the existing 90+ day A/R

Do not work every old balance in the same order.

Separate the inventory by payer, age, balance, denial reason, last action, filing or appeal deadline, responsible party, and likelihood that another action is required.

A high-value claim approaching an appeal deadline may deserve attention before a small balance that is already under active payer review.

Practices should also distinguish insurance A/R from patient balances because the collection workflows are different.

Prioritize the balances that require action

Each account should have a clear status.

Useful categories might include payer follow-up required, documentation needed, appeal required, corrected claim needed, credentialing issue, underpayment review, patient responsibility, pending payer response, or ready for adjustment.

Once categorized, each balance needs an owner and follow-up date.

This makes workload visible and prevents the same accounts from being reviewed repeatedly without progress.

Resolve rejections and denials before they become old A/R

Waiting for month-end aging reports is too late.

Clearinghouse rejections should be monitored routinely, and denials should enter assigned work queues as soon as payer responses arrive.

The practice should also track recurring denial categories.

If a large share of aged claims comes from the same authorization issue, payer configuration, provider enrollment problem, or documentation gap, continuing to appeal claims one at a time will not solve the underlying problem.

The workflow itself needs to change.

Tighten claim-submission lag

A claim cannot be paid before it is submitted.

Practices should monitor how many days pass between the date of service, charge entry, claim creation, and successful transmission.

MGMA’s RCM KPI guidance lists a service-to-bill rate under seven days as one revenue-cycle reference point.

The appropriate internal target will depend on the practice, but leadership should be able to identify which providers or locations consistently create submission delays.

Improve payment posting and reconciliation

ERA and EFT can support more efficient posting and reimbursement visibility when configured properly.

MBT’s clearinghouse services include ERA and EFT setup, while its medical billing services include payment posting and balance management.

Practices should routinely reconcile remittances, deposits, adjustments, and account balances so the A/R report reflects the actual financial position.

Prevent credentialing-related A/R

When old balances cluster around one newly hired provider or one payer, check enrollment status early.

Billing teams and credentialing teams should share visibility into effective dates, pending applications, group relationships, locations, and payer-specific restrictions.

This prevents A/R staff from repeatedly researching claims that cannot be resolved until a provider-enrollment issue is corrected.

Use technology to expose stalled claims

Technology is most useful when it helps the team identify what needs attention.

A strong billing environment should make it easier to see rejected claims, denied claims, missing responses, aging balances, posting issues, and outstanding follow-up.

Disconnected systems create the opposite effect: staff spend more time switching between portals, spreadsheets, billing applications, and payer websites trying to reconstruct the status of a claim.

MBT’s approach connects billing with clearinghouse and technology support so workflow problems and system problems can be addressed together rather than treated as unrelated issues.

A practical 90-day A/R improvement plan

Watch the trend, not only the benchmark

An organization at 12% A/R over 90 days that is improving steadily may be in a better operational position than one at 8% whose aging balance is increasing rapidly.

Practice owners should therefore compare current performance with previous months and analyze results by payer, provider, location, and service line.

That makes the report diagnostic.

If one payer drives most of the increase, leadership has a payer problem. If one provider drives it, there may be documentation, credentialing, or workflow issues. If aging increases across every payer, the practice may have a staffing, posting, or follow-up problem.

California IPA and DOFR considerations

California IPA and Division of Financial Responsibility arrangements can add another layer to A/R analysis because payment responsibility, encounter requirements, capitation, claim routing, and delegated arrangements may affect where a balance should be worked.

For these organizations, old A/R should not simply be grouped by payer name.

The team may also need to identify the financially responsible entity, contract requirements, routing rules, and whether the balance represents a claim, encounter, capitation-related issue, or another delegated workflow.

MBT’s California-focused billing model combines revenue-cycle services with clearinghouse and technology support, which can be valuable when A/R problems cross payer, workflow, and system boundaries.

What is medical accounts receivable management?

Medical accounts receivable management is the process of tracking, prioritizing, following up on, and resolving unpaid payer and patient balances after healthcare services have been provided.

What does A/R over 90 days mean?

A/R over 90 days is the portion of outstanding receivables that has remained unresolved for more than 90 days. It is commonly monitored because a growing older balance can signal problems with denials, follow-up, payment posting, payer processing, or other revenue-cycle workflows.

What percentage of medical A/R should be over 90 days?

MGMA revenue-cycle KPI guidance lists A/R over 90 days below 10% as a benchmark. Practices should use this as a reference rather than an absolute rule because specialty, payer mix, patient balances, and reimbursement models can affect performance.

What is a good days-in-A/R target?

MGMA’s KPI guidance lists approximately 30–40 days as an optimal range. Individual practice targets should be based on payer mix, specialty, historical performance, and operational complexity.

How is days in A/R calculated?

HFMA defines net days in A/R as net accounts receivable divided by average daily net patient service revenue. The metric is used to monitor overall revenue-cycle efficiency.

Why is my medical practice A/R increasing?

Common causes include late claim submission, rejected claims, unresolved denials, insufficient payer follow-up, underpayments, delayed payment posting, credentialing issues, patient balances, or disconnected billing systems.

How can a medical practice reduce accounts receivable?

To reduce accounts receivable, a medical practice should identify why balances are aging, prioritize actionable claims, assign clear ownership, resolve denials promptly, improve claim submission and posting, monitor filing deadlines, and correct recurring workflow problems.

What is the difference between A/R management and denial management?

Denial management focuses specifically on claims a payer has denied. A/R management covers the broader inventory of outstanding balances, including denied claims, pending claims, underpayments, patient balances, and other unresolved receivables.

How often should A/R be reviewed?

Operational teams should work active A/R continuously, while leadership should review aging, payer trends, denials, and related KPIs at least monthly. Practices with a significant backlog may need more frequent management reviews until performance stabilizes.

Can credentialing problems increase A/R?

Yes. Provider enrollment or credentialing issues can contribute to delayed or unresolved claims. If old A/R is concentrated around one provider or payer, enrollment status should be reviewed as part of the root-cause analysis.

Can clearinghouse issues cause A/R to age?

Yes. Failed routing, rejected claims, missing acknowledgments, or incorrect payer connections can delay claims before normal adjudication begins. Clearinghouse monitoring is therefore part of effective A/R management.

When should a practice outsource A/R management?

Outsourcing may be appropriate when the internal team cannot keep up with old balances while managing current claims, A/R continues to rise, denials remain unresolved, or leadership lacks the reporting and expertise needed to identify why cash is being delayed.