If you only look at one billing report each week, make it the accounts receivable (A/R) aging report. It shows every unpaid balance grouped by how long it has been outstanding, and it answers the question every practice owner eventually asks: where is our money, and how long has it been there?
The report is simple to produce and easy to misread. This guide walks through how it is built, what each bucket usually tells you, and how to turn it into a list of actions instead of a number you glance at and close.
What an A/R aging report actually shows
An aging report takes every open balance and sorts it into time buckets. The most common layout is:
- 0–30 days
- 31–60 days
- 61–90 days
- 91–120 days
- Over 120 days
Each row is usually a payer, a patient or a claim, and each column shows how much money sits in that bucket. The total at the bottom is your outstanding A/R.
Two settings change what the report means, so check them before reading anything else.
1. What date the aging starts from. Some systems age a balance from the date of service. Others age it from the date the claim was first submitted, or from the last time the claim was billed. Aging from the date of service shows the full delay, including slow charge entry. Aging from the last submission date can make old claims look new every time they are resubmitted. Know which one your report uses.
2. Whether insurance and patient balances are separated. Insurance A/R and patient A/R need different work. A combined report hides that. Ask for the report split by financial class (insurance versus patient responsibility) and by payer.
Reading each bucket
0–30 days: normal flow
Most new claims sit here while payers process them. The useful checks in this bucket are not about collecting yet. They are about making sure claims actually reached the payer:
- Were all billable encounters turned into claims?
- Were claims accepted by the clearinghouse and acknowledged by the payer, or did some reject and never come back into a work queue?
A claim that was rejected at the front door is not "in process". It is not in the payer's system at all, and the clock on timely filing keeps running.
31–60 days: the first follow-up window
Many clean claims are paid before this point, so balances here deserve a status check. Look up claim status on the payer portal or through your clearinghouse, and note what you find (status, reference number, date). Common findings are a request for more information, a coordination-of-benefits question, or a claim that is simply still pending.
61–90 days: something usually needs fixing
By now a balance often has a reason behind it: a denial nobody worked, a missing authorization, a credentialing problem, or a payer waiting on medical records. This is the bucket where denial management and A/R follow-up meet. Work it by reason, not just by age, so that ten claims with the same root cause are fixed together.
Over 90 and over 120 days: risk of losing the money
Older balances run into deadlines. Every payer has a timely filing limit for the original claim and separate deadlines for corrected claims and appeals. These limits differ by payer and contract. For Medicare, for example, the general rule is that a claim must be filed within 12 months of the date of service.
Do not write these balances off automatically. Review each one against:
- the payer's filing and appeal deadlines,
- proof of timely filing (clearinghouse acceptance reports, for example),
- the claim's status history and any open appeal,
- the documentation available to support a corrected claim or appeal.
Some old claims can still be corrected or appealed. Others cannot, and the honest outcome is an adjustment. The point is to make that decision on purpose, claim by claim.
Four things to check before trusting the totals
- Credit balances. Overpayments and unapplied payments show up as negative amounts and can make total A/R look smaller than it is. Review them separately.
- Unposted payments. If remittances (ERA/EOB) have arrived but are not posted yet, the report overstates what is owed.
- Duplicate or replaced claims. A corrected claim that did not void the original can leave two balances for one visit.
- Patient balances waiting on insurance. A balance should not move to the patient until the payer has processed the claim.
Turning the report into a weekly work plan
A useful aging review ends with a short list of assignments, not a percentage. A simple order of priority:
- Deadlines first. Claims close to a filing or appeal deadline, in any bucket.
- High-dollar claims. A small number of large claims can matter more than many small ones.
- Grouped root causes. Several claims denied for the same reason (an eligibility error, a missing modifier, an enrollment issue) can often be fixed as a batch, and the cause can be fixed at the front desk or in the charge workflow.
- Everything else by age and payer.
Track the outcome of each follow-up: what the payer said, the reference number, and the next action date. Without that history, the same claim gets called about again and again with nothing new to show for it.
What to track over time
The aging report is a snapshot. Trends tell you more. Many practices track:
- total A/R and how it changes month to month,
- the share of A/R over 90 days and over 120 days,
- A/R by payer, to spot a payer whose balances are growing,
- denials by reason, to find fixable patterns.
Set targets with your billing team based on your specialty and payer mix rather than borrowing a single number from somewhere else. A practice that bills mostly for high-cost procedures will look different from a primary care practice with many small visits.
Where outside help fits
If the over-90 buckets keep growing, the problem is usually capacity or process: not enough time for follow-up, denials that are not worked, or no one owning old claims after a staff change. That is the work a dedicated A/R follow-up and legacy A/R team is set up for. FZ Digital Solutions reviews old claims against payer rules, filing limits and appeal rights before deciding what can still be pursued, and works current A/R by priority. Outcomes still depend on payers, so no one can promise that every old claim will be paid.
If you would like a second opinion on your aging report, you can book a consultation. Please do not send patient information or PHI by email.
This article is general information about billing workflows, not legal or payer-specific advice. Payer rules and deadlines change, so confirm current requirements with each payer.