Accounts receivable days are one of those metrics that can drift in the wrong direction for months before anyone treats it as a problem requiring structural change. A practice running at 50 days instead of 35 does not feel like a crisis day to day, but the financial impact is real and accumulating. Every day that revenue sits uncollected is a day it is not available for payroll, reinvestment, or the operational needs of the practice.
What I have found, working through this problem with practices over the years, is that elevated A/R days are almost never caused by a single issue. They are the result of several smaller workflow gaps operating simultaneously, each adding a few days to the cycle, and none of them dramatic enough on their own to trigger an immediate response. The good news is that identifying and closing those gaps does not require a full system overhaul. It requires looking at the workflow from end to end and being willing to fix what is actually broken rather than what is most convenient to address.
That case study result from MBW RCM is worth examining.[3] A multi-specialty practice reduced A/R days from 55 to 33 within four months, not by replacing their billing team or implementing a new platform, but by targeting three specific workflow areas: A/R follow-up processes, automated eligibility tools, and front-end workflow tightening. Collections improved by 22 percent and claim rejections dropped by 35 percent. The intervention was focused and deliberate rather than comprehensive and disruptive.
Where A/R Delays Are Actually Created
Most A/R problems are born upstream of where they show up in the aging report. By the time a claim appears in the 61-to-90-day bucket, the decisions that put it there were often made weeks earlier, at the scheduling desk, during patient registration, or in the coding and charge capture process. Understanding where the delays originate is what allows you to design workflows that prevent them rather than recover from them.
Delayed or incomplete claim submission
Every day between the date of service and claim submission is a day added to A/R before the clock with the payer even starts. Claims that sit in a coding queue, wait for physician documentation, or require manual review before submission are adding controllable delay to the cycle. Automated claim submission workflows with daily or real-time transmission to payers eliminate most of this gap.[3]
Front-end errors generating denials and rework
As covered in Issue #01, a significant share of denials trace back to eligibility and registration errors at the front end. Each denial that results from a preventable front-end error adds days to A/R twice: once during the initial adjudication delay and again during the rework and resubmission cycle. Reducing front-end error rates has a compounding positive effect on A/R performance.[4]
Unworked or underprioritized A/R buckets
A/R follow-up that is not segmented and prioritized by aging bucket tends to allocate staff time inefficiently. Claims in the 0-to-30-day range require different actions than claims in the 61-to-90-day range. Without a structured workflow that assigns clear responsibility and timelines to each bucket, high-value aging claims frequently go unworked until they are close to the timely filing deadline or already past it.[3]
Slow or inconsistent denial follow-up
Denials that are not worked within a defined timeframe become increasingly difficult to recover. Payers have appeal deadlines, and claims that miss those windows are written off as uncollectable. A denial management workflow that triggers automatic follow-up tasks, tracks appeal status, and escalates stalled claims before deadlines pass is the difference between a recoverable denial and a write-off.[2]
"Improving your Days in A/R is not just about chasing payments. It is about building a robust, agile, and accountable revenue cycle."
MBW RCM, Best Practices to Improve Days in AR & Revenue Cycle [3]
A Real-World Scenario
Consider a group practice that had been running A/R days in the high 40s for over 18 months. Leadership was aware the number was above benchmark but had attributed it to payer slowness rather than internal workflow issues. A structured review of their A/R aging by source revealed a different picture.
About a third of their 60-plus-day A/R was concentrated in claims that had never been reworked after an initial denial. They were being logged in the denial tracking system, but no follow-up task was being generated and no timeline was being enforced. Another significant portion traced to claims where the coding queue was holding submissions for two to four days beyond the date of service due to a bottleneck in physician sign-off on documentation.
Two targeted workflow changes addressed both issues: an automated denial follow-up trigger that created a task and assigned ownership within 48 hours of a denial posting, and a documentation turnaround policy with a 24-hour window for physician sign-off on high-volume procedure types. Within 90 days, A/R days had dropped from the high 40s to 37, with collections up by roughly 18 percent on the previously unworked denial inventory.
Where to Start This Week
Reducing A/R days starts with an honest assessment of where the delays in your current workflow are actually coming from. Here is a structured starting point for that analysis.
Calculate your current average submission lag. What is the average number of days between date of service and claim submission? If it is more than two days, there is a workflow gap in your coding or charge capture process that is adding controllable delay to every claim in your system.
Pull your 90-plus-day A/R and break it down by payer and denial reason. Aggregate aging numbers hide the specific patterns that drive them. Identifying which payers and which denial categories are disproportionately represented in your oldest A/R tells you exactly where to focus your follow-up resources.
Audit your denial follow-up workflow for ownership and timelines. For every denial that enters your system, there should be a defined owner, a defined action, and a defined deadline. If any of those three elements are missing, denials are being worked inconsistently, and some are not being worked at all.
Review your write-off policy and the claims that triggered it in the last 90 days. Write-offs represent revenue that was collectible but not collected. Reviewing what drove them, whether it was missed appeal deadlines, timely filing limits, or unworked balances, tells you which workflow gaps have a direct cost attached to them and which ones to fix first.
A/R days above benchmark are not a fixed condition of doing business in healthcare. They are a symptom of specific, identifiable workflow gaps, and closing those gaps produces measurable financial improvement in a timeframe that is visible within a single billing cycle. The practices that get this right are the ones that are willing to look honestly at where the delays are being created rather than where they are showing up.
In Issue #05, we will look at how to read payer behavior through EDI data, specifically how the 835 and 837 transaction files that are already flowing through your clearinghouse contain patterns that can tell you a great deal about what your payers are doing and why your claims are being adjudicated the way they are.
- MD Clarity and HFMA (2025). RCM Benchmarks: How Close Does Your MSO Come to These Ideal Measurements? MD Clarity is an RCM software and analytics platform specializing in physician groups and managed service organizations. This article consolidates benchmark data from the Healthcare Financial Management Association (HFMA), MGMA, and Kodiak Solutions, making it a useful reference for evaluating A/R performance against verified industry standards. mdclarity.com →
- HFMA (December 2024). Hospital Financial and Revenue Cycle Benchmarks. The Healthcare Financial Management Association is the leading professional organization for healthcare finance executives. The A/R days trend data cited here, including the 5.4% year-to-date increase, comes from Kodiak Solutions benchmarking data as reported in HFMA's end-of-year revenue cycle analysis. hfma.org →
- MBW RCM (2024). Best Practices to Improve Days in AR and Revenue Cycle. MBW RCM is a revenue cycle management services firm. The case study referenced here describes a documented multi-specialty practice outcome achieved through targeted workflow intervention, including A/R follow-up restructuring, automated eligibility tools, and front-end process tightening. mbwrcm.com →
- Experian Health (September 2025). State of Claims 2025. Experian Health's annual State of Claims survey is one of the most widely cited industry benchmarks for revenue cycle management, drawing on responses from 250 healthcare professionals across provider organizations of varying sizes and specialties. experian.com →
- Becker's Hospital Review (December 2023). 3 Steps to Clean Up Accounts Receivable and Improve Financial Performance. Becker's is one of the most widely read trade publications in hospital administration and revenue cycle management. This article provides practical, operational guidance on A/R clean-up strategies that remain relevant and applicable for practices working to reduce aging receivables. beckershospitalreview.com →
Ready to bring your A/R days down?
The ROI platform includes workflow tools and analytics specifically designed to surface A/R gaps and help your team act on them before they age into write-offs.