What is aged medical A/R?
Aged medical accounts receivable (A/R) is money owed to a healthcare practice for services already rendered that has remained unpaid beyond its normal payment period. Practices commonly track A/R in 0–30, 31–60, 61–90, 91–120, and 120+ day buckets, measured from the date of service or the claim date.
How aged A/R is measured
An aging report groups every open balance by how long it has been outstanding. Insurance A/R (owed by payers) and patient A/R (owed by patients) are aged separately because they are worked differently. Most practice-management systems age from the date of service; some age from the date the claim was submitted, which flatters the report by a few weeks. Know which one yours uses before comparing to a benchmark.
| A/R age | Typical priority | What is usually happening |
|---|---|---|
| 0–30 days | Routine monitoring | Claim submitted; payer adjudicating |
| 31–60 days | Follow-up | Pending, rejected at the clearinghouse, or first denial |
| 61–90 days | Escalation | Denied, stalled, or waiting on records |
| 91–120 days | Recovery priority | Unworked, under appeal, or lost by the payer |
| 120+ days | Immediate recoverability review | Filing and appeal windows closing |
Why aged A/R matters more than its dollar value suggests
Aged claims decay on payer deadlines. Medicare requires claims to be filed within one calendar year of the date of service and allows 120 days from an initial determination to request a redetermination, according to CMS. Commercial contracts commonly set 90–180 days for filing and 60–180 days for appeals. A claim that ages past those windows without action is not merely late; it becomes uncollectible by contract. Aged A/R is therefore a measure of two things at once: cash that has not arrived, and cash that is about to be lost permanently.
What causes A/R to age
- Denials that are never appealed. The denial reason is not worked because new claims pay faster and are prioritized.
- Claims with no follow-up on file. Common after staff turnover, a billing-company change, or a system migration. See what happens to A/R when you switch billing companies.
- Underpayments accepted as paid. The claim shows a payment, so it drops out of the denial queue even though it paid below contract.
- Documentation requests that time out. Records or authorizations requested by the payer are not returned before the deadline.
- Payer processing errors. Claims the payer has no record of, or adjudicated under the wrong contract.
Is aged A/R recoverable?
Much of it is, inside the deadlines. HHS's Office of Inspector General found that 13% of sampled Medicare Advantage prior-authorization denials and 18% of payment denials met Medicare coverage and billing rules and should have been approved or paid (OIG, 2022). A practical review sorts every aged claim into recoverable (correct, appeal, or dispute), pending (waiting on the payer), and unrecoverable (past every deadline or a true contractual adjustment), and works the first group by deadline. See is 120+ day medical A/R still recoverable?
Rule of thumb. If more than about 15–20% of your insurance A/R is over 90 days, the aged queue is large enough to be worked as its own project rather than as an afterthought to current billing. That threshold is a commonly used industry target, not a published standard; benchmark against MGMA or HFMA data for your specialty.
Sources
- CMS, Medicare timely filing requirements: claims must be filed within one calendar year of the date of service
- CMS, Original Medicare (fee-for-service) appeals: five levels; redetermination within 120 days, reconsideration within 180 days
- HHS Office of Inspector General, OEI-09-18-00260 (April 2022): 13% of sampled Medicare Advantage prior-authorization denials and 18% of payment denials met Medicare coverage and billing rules
- 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.
- Medical A/R recovery — 90+ day insurance claims for medical practices, on contingency.