Accounts receivable follow-up in depth: aging, metrics and priorities
Accounts receivable (A/R) follow-up is the work of reviewing unpaid claims and patient balances by payer and age, then resolving them before they become uncollectible. It protects cash flow and shows early where front-end or coding problems are causing payment delays.
Aging buckets
A/R is usually grouped into 0–30, 31–60, 61–90, 91–120 and 120+ day buckets, measured from the date of service or claim submission. The older a balance gets, the lower the chance of full payment, so many teams watch the share of A/R over 90 days closely.
Key metrics
| Metric | How it is calculated | Commonly cited target |
|---|---|---|
| Days in A/R | Total A/R divided by average daily charges | About 30–40 days for many practices |
| Net collection rate | Payments divided by amount collectible after contractual adjustments | 95 percent or higher |
| Clean claim rate | Claims accepted on first submission divided by claims submitted | 95 percent or higher |
| A/R over 90 days | Balance older than 90 days divided by total A/R | Kept as low as possible |
Targets vary by specialty and payer mix, so use them as reference points rather than guarantees.
How follow-up is prioritized
- Build an aged A/R report by payer, then rank accounts by balance and remaining filing or appeal time.
- Check claim status through the payer portal or the electronic 276/277 transaction.
- Work denials by reason code and payer, and resubmit or appeal as the cause requires.
- Review payments against the contract fee schedule to find underpayments.
- Escalate payer-wide delays and document every call, reference number and promised payment date.
- Bill patient responsibility promptly once the payer has adjudicated.
Common causes of aged A/R
- Missing or invalid claim data, rejected before the payer processed it
- Authorization or eligibility problems found after the visit
- Unworked denials and unposted payments
- Slow payer processing without follow-up