Most practice owners look at their 90-day AR report and see a number. What they don’t see is a deadline.
Every dollar in that column has a clock running. Commercial payers give you 90 to 180 days from the date of service to appeal a denied claim. Medicare gives you 120 days from the remittance date. Miss the window — by a day, a week, a month of neglect — and that dollar is gone. Permanently.
90-day AR isn’t a billing metric. It’s a countdown.
What the Number Actually Represents
When a claim lands in 90-day AR, one of three things happened: it was denied and nobody followed up; it was submitted and got no response (requiring a payer call, not a resubmission); or it was resubmitted without fixing the root cause.
By the time a claim hits 90 days, any of these three paths has already cost you something. The question is whether it’s still recoverable.
The Money You Don’t Even Know Is Missing
The most expensive AR isn’t the aging AR on your report. It’s the AR that never made it to the report.
Claims rejected at the clearinghouse — not denied, rejected — never enter your AR aging. They show up in an error log that most billers check inconsistently and most practice owners never see.
An internal medicine practice came to us after noticing inconsistent cash flow. The physician had recently added a second clinic — his wife running a pulmonology practice out of the same group. She had been seeing patients for three months. The physician assumed the new clinic was just slow to ramp up.
When we ran the audit in Office Ally and Practice Mate, we found the problem immediately. Her NPI had never been added to the group’s payer enrollment. Every single claim she had submitted across three months had been rejected at the clearinghouse — not denied, rejected. None of it appeared in the AR aging report. The practice had billed $30,000 in services and collected zero dollars of it.
We fixed the enrollment, resubmitted the corrected claims, and recovered the full $30,000 in the same billing cycle. She is now in-network with all major payers at market contract rates.
Timely Filing Windows
| Payer Type | Typical Filing Window | After Window Closes |
|---|---|---|
| Medicare | 12 months from date of service | Unrecoverable |
| Most commercial (PPO/HMO) | 90–180 days (contract-specific) | Unrecoverable |
| Medicaid | Varies by state (60–365 days) | Unrecoverable |
| Workers’ Comp | Varies by state law | Unrecoverable |
What to Do If Your 90-Day AR Is High
Start with the claims closest to their timely filing window — not the largest balances. A $180 claim at 170 days is more urgent than a $2,000 claim at 60 days. Then map denial reason codes across all 90-day claims. If the same code appears on 15 or 20 claims, that’s a root cause. Fix it at the source. Then pull your clearinghouse rejection log separately. That’s where the $30,000 hides.
Frequently Asked Questions
What percentage of AR should be over 90 days?
Best-in-class practices keep 90-day AR under 1% of total AR. The industry average is 15–25%. Everything in that gap is recoverable revenue sitting on a deadline.
What’s the difference between a clearinghouse rejection and a payer denial?
A rejection happens before the claim reaches the payer. Rejections do not appear in your AR aging report — making them invisible until someone specifically pulls the rejection log. A denial happens after the payer reviews the claim and does appear in AR.
If your AR report doesn’t look right, the 4-week free pilot shows you exactly what’s there. No contracts. No obligation.
Book a free 15-minute call at drbillerz.com
Sumit Nair | Founder, Dr. Billerz
