Days in A/R is a symptom, not a diagnosis

Days in accounts receivable is the number most practices watch and the number that explains the least. It is a ratio of outstanding receivable to average daily charges, which means four unrelated processes feed it. When it rises, the useful question is not "how do we collect faster" but "which of the four moved."

Check one: charge entry lag

If charges are entered five days after the visit instead of one, the receivable ages before a payer ever sees it. This shows up as a broad, even worsening across all payers, and it is invisible in denial reporting because nothing has been denied. Measure the gap between date of service and date of submission as its own metric.

Check two: payment posting

Money that has arrived but has not been posted sits in the receivable and ages exactly like an unpaid claim. Practices with a lockbox, multiple bank accounts, or a backlog of paper remittances are especially exposed. Reconcile deposits against posted payments for the period before concluding anything about collections.

Check three: segment by payer

Practice-wide averages hide single-payer problems. One plan that has changed its adjudication process, moved to a new portal, or started requesting records on a specific service line can move the blended average enough to look like a systemic decline. Run the aging by payer and by financial class, and compare each against its own prior quarter rather than against the practice average.

Check four: what is actually in 90+

The over-90 bucket is usually a mix of four different things, and each needs a different response: claims genuinely in appeal, claims never worked, small balances that cost more to pursue than they return, and balances that should have been written off under contract months ago. Until the bucket is separated, any effort spent on it is spread across categories where most of the work has no return.

• In appeal — track to the payer's decision date, not to the submission date.
• Never worked — the real problem; assign and date it.
• Small balance — set a threshold and a documented policy rather than deciding case by case.
• Contractual — write it off and stop reporting it as collectable.

Then set the cadence

Aged A/R rebuilds unless follow-up happens on a schedule. A weekly pass on the 31–60 bucket prevents more 90+ than any amount of work inside 90+ ever recovers, because a claim's chance of full payment falls with every aging bucket it crosses.

If you want a starting read on where your own numbers sit, the benchmark tool compares your aging buckets and denial rate against published industry bands and returns a shareable scorecard.