90-day vs. 120-day A/R: what practices should prioritize
Prioritize by deadline first, recoverability second, and balance third, not by aging bucket. The 91–120 day bucket usually yields the most recovered dollars per hour because its appeal windows are still open. The 120+ day bucket jumps the queue only for claims within 30 days of a filing or appeal limit; the rest of it is worked after the 91–120 bucket.
What is different about each bucket
| 91–120 days | 120+ days | |
|---|---|---|
| Typical state | Denied, pended, or unworked; most windows open | Under appeal, lost, or past a deadline |
| Medicare appeal position | Inside the 120-day redetermination window (CMS) | Redetermination window closing or closed; reconsideration may remain |
| Commercial position | Inside most 60–180 day appeal windows | Many appeal windows closed; filing limit may remain for corrected claims |
| Yield per hour worked | Highest | Lower, except deadline-exposed claims |
| Risk of doing nothing this month | Moderate | High: each month closes more windows |
The working order for a mixed queue
- Deadline-exposed claims in any bucket: anything within 30 days of a timely-filing or appeal limit, regardless of balance.
- 91–120 day claims by recovery path: not-on-file refiles and coding corrections first (fast), then authorization and medical-necessity appeals (slower, higher value).
- Underpayments in both buckets: cheap to identify in bulk against the fee schedule; contract dispute windows are often separate from claim appeal windows.
- 121–180 day claims with open windows, by balance.
- 180+ day claims: sort into alive and dead; work the alive, document the dead for write-off.
Why deadlines outrank balance
A $12,000 surgical claim with 90 days left on its appeal window will still be there next week. A $900 claim with six days left will not. Medicare's appeal levels each carry their own clock, beginning with 120 days for a redetermination and 180 days for a reconsideration after that (CMS). Missing one closes the path permanently. Sorting by balance feels productive and quietly loses the small claims that add up to the largest share of a specialty practice's aged queue.
What to measure
Measure the aged queue on recovered dollars per claim worked and on deadline misses (which should be zero), not on days in A/R. Days in A/R will fall as a consequence. The two-bucket percentages, 90+ and 120+ as a share of total A/R, are the trend lines to watch monthly against MGMA and HFMA benchmarks.
Sources
- CMS, Original Medicare (fee-for-service) appeals: five levels; redetermination within 120 days, reconsideration within 180 days
- CMS, Medicare timely filing requirements: claims must be filed within one calendar year of the date of service
- MGMA DataDive: practice operations, A/R, and revenue-cycle benchmarks
- HFMA MAP Keys: standard revenue-cycle metrics including days in A/R and aged A/R as a percentage of total A/R
Figures attributed to a source are that source's; commonly used benchmarks are labeled as such. Verify deadlines against your own payer contracts.
Related articles
Related services
- Aged A/R recovery — Claims past 90, 120, and 180 days, worked by deadline and recoverability.