What percentage of medical A/R should be over 90 days?
A commonly used target is to keep insurance A/R over 90 days below 15–20% of total A/R, and A/R over 120 days below roughly 10–12%. Well-run specialty practices often run lower. These are widely used rules of thumb rather than a regulatory standard; MGMA DataDive and HFMA MAP Keys are the benchmark sources practices compare against.
The metrics and how to calculate them
| Metric | Formula | Commonly used target |
|---|---|---|
| Percent of A/R over 90 days | A/R aged > 90 days ÷ total A/R | Under 15–20% |
| Percent of A/R over 120 days | A/R aged > 120 days ÷ total A/R | Under 10–12% |
| Days in A/R | Total A/R ÷ (annual gross charges ÷ 365) | Under 40–50 days |
| Net collection rate | Payments ÷ (charges − contractual adjustments) | 95% or higher |
HFMA's MAP Keys define "aged A/R as a percentage of total billed A/R" by age bucket as a standard revenue-cycle metric, and MGMA publishes specialty-level A/R distributions in DataDive. Use those for your specialty; a surgical practice with heavy prior-authorization volume will not look like a dermatology practice.
Why 90 days is the line
Most clean claims adjudicate in 14–45 days. A claim still open at 90 days has almost always hit a problem: a denial, a records request, a coordination-of-benefits question, or a payer that lost it. From that point the claim is racing appeal deadlines. Medicare allows 120 days from the initial determination for a redetermination (CMS); commercial contracts often allow 60–180 days. The 90-day bucket is where recoverable money starts becoming unrecoverable.
What a high percentage usually means
- Above 20% and rising month over month: the billing team is under-staffed for follow-up, or a workflow (authorizations, eligibility) is generating denials faster than they are worked.
- A sudden jump in one quarter: a vendor change, a system migration, or the departure of a billing manager. Look for claims with no notes.
- High percentage concentrated in one or two payers: a contract or credentialing problem, or a payer-side processing issue worth escalating to provider relations.
- High percentage of small balances: often underpayments and secondary claims that were never billed, which are cheap to fix in bulk.
What to do if you are above target
- Pull the 90+ day insurance aging by payer and by denial reason. Denominators matter: exclude patient balances and credit balances.
- Sort by deadline first, then by balance. Anything within 30 days of a filing or appeal limit is worked before anything else.
- Separate the queue from current billing. A team measured on days in A/R will always work this week's claims first; aged claims need a dedicated owner. See should you outsource aged A/R?
- Report root causes back to the front end so the percentage stops regrowing.
Sources
- 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
- 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
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.