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How Much Medical A/R Over 90 Days Is Too Much? (Free A/R Health Guide)

How Much Medical A/R Over 90 Days Is Too Much?

By Brad Becker, CRCR, Regional Billing Manager at AMS Solutions. 10-page printable PDF, free.

You pulled your accounts receivable aging report. There is money in the 0-30 bucket, more in 31-60, some in 61-90. Then you reach 91-120 and over 120 days, and the obvious question appears. For most practices, lower is better, but a percentage alone does not tell you whether the revenue cycle is healthy. You also need to know what is sitting in that A/R, why it is still unpaid, whether someone is working it, whether the trend is improving and whether the money is still collectible.

What’s inside

Who it’s for

Practice owners, administrators and billing managers who want to read their own aging report with confidence and ask their billing team the right questions.

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What A/R over 90 days actually means

Accounts receivable is money still owed to the practice for services already provided. A typical aging report separates balances into 0-30, 31-60, 61-90, 91-120 and over-120-day buckets. HFMA’s MAP Keys define aged billed A/R using these same categories and, for ambulatory and physician organizations, age receivables from the date of service. A large A/R balance is not automatically bad; practices will always have receivables because payment follows care. What matters is how much of the money is becoming old.

How to calculate it

Add the balances in the 91-120 and over-120 buckets, divide by total billed A/R and multiply by 100. For example, with $500,000 of total billed A/R, $35,000 at 91-120 days and $40,000 over 120 days, the total over 90 days is $75,000, or 15%.

Is 10% the magic number?

No. There is no single percentage that fits every specialty and payer mix. Across AMS Solutions’ active client base, less than 10% of total A/R is over 90 days, and AMS’s 2026 benchmark report cites an industry reference of approximately 13.5%. As practical review thresholds: under 10% is generally a strong position, assuming balances are accurate and actively managed; 10 to 15% is worth watching closely, looking at trend, payer concentration and what is driving the aging; 15 to 20% means meaningful aged A/R is accumulating and leadership should understand exactly why; over 20% warrants a deeper review that may involve denials, follow-up, credentialing, patient A/R or claim submission. These are practical thresholds, not universal standards.

The trend matters more than the snapshot

Practice A has 12% of A/R over 90 days, down from 19% six months ago. Practice B has 9%, up from 5%. Practice B still has the lower number, but its trend is more concerning. Ask for the trend: what was it last month, three months ago, six months ago, and what is causing the movement? Not all old A/R is the same, either. A dollar over 90 days might be a claim under appeal, a records request, a credentialing problem, a patient balance, an authorization denial, an underpayment, a posting issue or a claim nobody followed up on. “How much?” is only the beginning; the next question is “what is in it?” Break the A/R down by payer, since $55,000 of a $90,000 aged balance concentrated with one commercial payer is a much more useful problem, and look at dollars as well as percentages: 10% of $100,000 is $10,000, while 10% of $2 million is $200,000.

Why medical A/R gets old

  1. Claims were submitted late. Unclosed encounters, missing charges, coding backlogs, documentation delays and held claims create aging before the payer ever sees the claim.
  2. Claims are getting rejected. A rejected claim has generally not entered adjudication; clearinghouse edits, demographics, insurance data and provider information can let claims age quietly while everyone assumes they were billed.
  3. Denials are not being resolved. Authorization, eligibility, coding, medical-necessity, credentialing, timely-filing and coordination-of-benefits denials all push balances into older buckets.
  4. The same denial keeps happening. Overturning the same preventable denial every month is activity, not improvement.
  5. Credentialing or enrollment is holding claims. Missing reassignment, an unenrolled location or a provider seeing patients before enrollment is complete can leave clean claims unpaid for months.
  6. Nobody is meaningfully following up. Clicking “check claim status” every few weeks is not a strategy.
  7. Payments are not being posted correctly. Unposted ERAs, delayed paper EOBs, unapplied payments and missing adjustments make A/R look older than it is.
  8. Patient balances are aging. Statement frequency, payment options, returned mail and incorrect insurance-to-patient transfers all matter; know how much old A/R is insurance versus patient.
  9. The balance may no longer be collectible. Missed deadlines, missing authorization, inadequate documentation and true bad debt eventually make balances hard or impossible to recover.

The “we’re working it” test

If the answer to a question about aged A/R is “we’re working it,” ask another question. What are the five largest balances? Which payers account for the most aged A/R? What are the biggest causes? What action was taken? What happens next? Look at touches, but do not worship them: four notes that all say “portal checked, still pending” are activity, not progress. Pay particular attention to the over-120 bucket, and make sure every meaningful balance has an owner. The most dangerous A/R is often not the oldest balance; it is the balance nobody owns.

What your monthly A/R review should include

Total A/R, days in A/R, A/R over 90 days, A/R over 120 days, A/R by payer, patient versus insurance A/R, the top aged balances, denial trends and the A/R trend. Then the five-question A/R test: What percentage of our A/R is over 90 days? What percentage is over 120? Which five payers account for the most aged A/R? What are the three biggest reasons those balances remain unpaid? What are we doing to reduce the number next month? A report tells you what happened; a revenue-cycle strategy tells you what happens next.

What should happen next

If your A/R over 90 days is higher than expected, do not start by demanding that everyone work harder. Diagnose first: determine whether the aging comes from submission, rejections, denials, payer processing, credentialing, posting, patient balances, follow-up, internal workflows or genuinely uncollectible balances. Old A/R is a lagging indicator; today’s 120-day balance was created months ago. Work the money that is already old, and stop today’s claims from becoming tomorrow’s old A/R. Having receivables over 90 days does not mean your billing operation is failing. What matters is whether the practice understands how much is aging, why, who owns it, whether it is collectible, what is being done and whether the trend is improving. If you cannot answer those questions, the most important problem may not be the percentage; it may be the lack of visibility. The downloadable guide includes the 15-minute A/R health-check worksheet.

Prefer the printable version with the worksheets and checklists? Use the form above. And if you would like a second set of eyes on your own numbers, AMS Solutions offers a no-obligation review of your A/R and recent billing performance: call 866-973-2221 or email info@ams-solutions.com.

This guide is for general operational and educational purposes. Payer rules, contracts, timely-filing limits and practice circumstances vary; results are not guaranteed.

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