How to Read Your A/R Aging Report (and What to Fix First)

Every practice has money sitting in accounts receivable. The real question is whether it’s moving. Your A/R aging report answers that, but only if you read it as a to-do list instead of a monthly formality.

The report breaks unpaid balances down by how long they’ve been outstanding, and it tends to reveal problems well before they show up in your bank account. In an MGMA poll of medical practice leaders, 49% said their days in A/R increased in 2021, while only 15% saw a decrease. If your numbers are creeping up, you’re in good company, and you can fix it.

This guide covers what each part of the report means, what a healthy report looks like, the red flags worth acting on, and a simple order for deciding which claims to work first.

What an A/R aging report shows

An A/R aging report lists every unpaid balance and sorts it into buckets based on how many days have passed since the date of service or claim submission. Most reports use 0 to 30, 31 to 60, 61 to 90, 91 to 120, and 120+ day buckets, and can be filtered by payer, provider, or patient versus insurance balances.

Two views matter most. Total A/R by bucket shows how your balance is spread over time. A/R by payer shows whether a problem is general or tied to one insurer.

Keep insurance and patient balances separate. They age for different reasons and need different follow-up, so mixing them hides what’s really going on.

How to read each aging bucket

Each bucket tells you something different. The 0 to 30 day bucket is normal work in progress. The 31 to 60 day bucket deserves a status check. Balances at 61 to 90 days need active follow-up, and anything past 90 days is at real risk of never being collected.

0 to 30 days

Most clean claims pay in this window. A large balance here usually just reflects recent patient volume, not a problem.

31 to 60 days

Claims here may be pending, lost, or waiting on information the payer requested. This is the cheapest point to step in, because a quick status check often gets the claim moving again.

61 to 90 days

Something has usually gone wrong by now, such as a rejection nobody saw or a denial waiting in a queue. These claims need a person looking at them, not another automated resubmission.

90 days and older

Every week counts in this bucket. Some claims are getting close to payer filing limits. Original Medicare, for example, requires claims to be filed within 12 months of the date of service, and commercial plans are often shorter.

What a healthy A/R aging report looks like

A healthy report keeps most of its balance in the first two buckets and a small, steady share in the oldest ones. MGMA benchmark data put the median share of A/R over 120 days at 13.54% for multispecialty practices, so a rising share in that bucket is a signal to act.

Benchmarks vary by specialty and payer mix, so treat them as a reference point rather than a pass or fail grade. The most useful comparison is your own practice over time. If the oldest buckets hold a bigger share this quarter than last, follow-up isn’t keeping pace.

Five red flags in your A/R aging report

Some patterns show up again and again in practices with cash flow trouble. None of them fix themselves.

1. Your 90+ day share grows two or three months in a row. That usually means follow-up isn’t keeping up with new claims.
2. One payer holds a big part of your old balances. That points to something specific, like an enrollment problem, a missing authorization pattern, or a coding rule that payer enforces.
3. High-dollar claims sit untouched. When the team works claims in the order they appear, the biggest balances can wait the longest.
4. Denials show up as open A/R. A denied claim that nobody has corrected or appealed looks like slow payment on the report. Our denial management process treats these as a separate queue for that reason.
5. Credit balances appear. Overpayments you owe back to payers or patients also need attention and shouldn’t sit on the report.

What to fix first: a simple priority order

Work aging claims in order of risk. The highest-value claims closest to a filing or appeal deadline come first, then high-value claims that are simply slow, then smaller balances. This keeps your team focused on the money most likely to be lost.

Start by sorting the 61+ day buckets by payer and dollar amount, then flag anything near a filing or appeal deadline. Check each flagged claim’s status with the payer, fix what’s missing, and resubmit or appeal. Record why each claim was stuck so you can spot the pattern later.

This is slow, detailed work, and it’s getting harder. In Experian Health’s 2025 State of Claims survey, 90% of respondents said denials need human review before they can be resubmitted. If your team can’t keep up, dedicated A/R recovery support can work the backlog while your staff handles new claims.

How often to review your A/R

A full review of the A/R aging report once a month is a good baseline, with a quick weekly look at anything past 60 days. The monthly review should include the practice owner or manager, not just the billing team, because the patterns often point to front-desk or documentation fixes.

Look at the same views every time so changes are easy to spot: total by bucket, the share past 90 days, and the top payers in the oldest buckets. Clear monthly reporting makes this a ten-minute conversation instead of an afternoon in spreadsheets.

Put your A/R aging report to work

Your A/R aging report is most useful when it drives action. Read it by bucket and by payer, watch the share of balances in the oldest buckets, and work claims by value and deadline rather than order of arrival. Small, steady follow-up keeps money from drifting past the point where it can be collected.

If your practice doesn’t have the time to work aging claims every week, Optima Care Billing can help, from full revenue cycle management to a focused A/R cleanup. Contact us for a free billing audit, and we’ll show you where your A/R is stuck and what to fix first.