How to Reduce Medical Accounts Receivable Over 90 Days
A medical practice can report a large accounts receivable balance and still struggle with cash flow. The key question is not simply how much is outstanding. It is how much remains collectible, what is delaying payment, and which balances require action now.
For California practice owners and administrators, the goal is to recover money the practice is owed while keeping the aging report accurate. Start with insurance balances over 90 days, but address filing and appeal deadlines before a claim reaches that age.
What does aging AR actually tell you?
An accounts receivable aging report groups unpaid balances by how long they have remained outstanding. Insurance and patient balances should be reviewed separately because the next steps, deadlines and collection methods differ.
Confirm whether your software ages balances from the date of service or another date, and use the same basis when comparing reports. The AMA's revenue cycle management guide treats payer aging and patient aging as separate measures.
Balances older than 60 or 90 days deserve closer attention, but age alone does not establish that a claim is uncollectible. Some claims are pending appeal, medical records, coordination of benefits or payer review. Others may be duplicated, adjusted incorrectly or already paid but not posted.
Start by separating collectible and noncollectible balances
Review the latest ERA or EOB, payer claim status, timely filing and appeal deadlines, contractual allowances, patient responsibility and any previous follow-up. An aging report should distinguish claims that are actively being pursued from balances awaiting documentation, patient action or an approved adjustment.
Five steps to reduce old insurance AR
1. Reconcile payments first. Check whether deposits and ERAs were posted correctly before chasing a claim that may already be paid.
2. Group balances by payer, denial reason and age. A repeated issue involving the same payer or procedure may require a systemic fix.
3. Prioritize by collectible value and deadline. High-dollar appeals and claims approaching filing deadlines should not wait behind routine low-dollar follow-up.
Aging buckets are not filing deadlines. For example, Medicare fee for service redetermination requests generally must be filed within 120 days of receiving the initial claim determination. Check the actual notice and current payer rules rather than applying one deadline to every insurance plan.
4. Record a clear next action and owner. Notes such as 'followed up' are not enough; capture what the payer said, what evidence is needed and when the claim will be reviewed again.
5. Review adjustments and write-offs through an approved process. Distinguish contractual adjustments from balances that are genuinely uncollectible, and document the rationale before removing amounts from AR.
Why proactive write-off review matters
Some appropriately billed services may ultimately prove noncollectible after reasonable payer and patient collection efforts. Leaving those balances indefinitely in open AR inflates the report and obscures the money the practice can realistically pursue. Write-offs should follow documented practice policies and applicable payer and legal requirements, not be used to hide avoidable denials.
A lower AR total does not necessarily mean more cash was collected. Report actual payments separately from contractual adjustments and approved write offs. Do not automatically transfer an unpaid insurance balance to a patient; confirm responsibility and applicable requirements first.
What to ask your billing company
Ask for separate insurance and patient aging, balances over 60 and 90 days, top payer issues, appeal status, recent recoveries, and proposed adjustments with supporting explanations. Useful reporting should help the practice decide what action to take rather than simply present a large total.
Set a regular review meeting with a named owner for each unresolved issue. The AMA recommends weekly or monthly reviews with an outside billing company that cover aging reports and the time between claim creation, submission and payer acceptance.
How HRS supports actionable AR
Horizon Revenue Solutions provides insurance AR follow up, denial resolution, payment posting and clear financial reporting for California practices. Our team works with the software your practice already uses and follows a thorough process to help maximize collections.
Interested in improving your billing collections? Contact Horizon Revenue Solutions at (408) 444-8845 to discuss a complimentary billing review.
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