Every practice management system produces an ageing report. Most practices look at the total and very few use it as what it is: a prioritised work list where the priority changes every week.
The buckets
The standard buckets are 0–30, 31–60, 61–90, 91–120 and over 120 days, measured from the date of service or the date of submission depending on your system. Know which one your report uses, because the difference can be a fortnight.
Collection probability falls sharply as balances move right:
- 0–30 days — above 95%. Most of this is simply in transit.
- 31–60 days — 85–90%. Claims here are usually pended or awaiting a first response.
- 61–90 days — 70–80%. Something has gone wrong and nobody has looked yet.
- 91–120 days — 50–60%. Appeal and filing windows start closing.
- Over 120 days — below 30%. Recoverable, but only with deliberate work.
These are industry benchmark ranges, cited to MGMA and HFMA. Your own curve is worth measuring, because payer mix moves it.
Why the oldest bucket is not always the priority
The instinct is to work the oldest balances first because they look worst. That is usually wrong.
The right ordering is by deadline proximity and collectability together. A $2,400 claim at 85 days with a 90-day filing deadline is more urgent than a $180 claim at 200 days with no remaining appeal rights. One is about to become uncollectable; the other already is.
A working triage looks at three things per account:
- How many days remain before the filing or appeal window closes
- The expected collectable amount, not the billed amount
- Whether anything can actually be done — a corrected claim, an appeal, a payer call
Accounts that fail the third test belong in a write-off recommendation with a stated reason, not in a queue that never moves.
Reading the shape of the report
The distribution across buckets tells you more than the total.
A large 0–30 bucket and very little beyond it is what healthy looks like. Money is moving.
A bulge at 31–60 usually means claims are being submitted but not followed up until something prompts it. The fix is cadence.
A bulge at 61–90 normally means denials are arriving and not being worked. Look at your denial turnaround time before looking at anything else.
A large over-120 block that never changes size is the classic signature of a practice that works new claims and abandons old ones. It is also where the fastest recoverable money usually sits, because nobody has tried.
By payer, not just by age
An ageing report split only by date hides the actionable pattern. Split it by payer as well.
One payer carrying a disproportionate share of aged balance is a specific, solvable problem — a contracting issue, an enrolment gap, a systematic denial reason, or a payer that simply does not pay without being chased. That is a conversation you can have. "Our A/R is too high" is not.
The practical habit
Run the ageing report weekly, not monthly. Split it by bucket and by payer. Work it by deadline. Document every payer contact with a reference number, because the second call is far more productive than the first when you can quote what you were told.
If more than a fifth of your A/R sits past 90 days, that is the finding — and it is worth measuring properly before deciding what to do about it.