A well-run practice keeps roughly 10–15% of its total accounts receivable in the 120-plus day bucket. Much above that and money is aging out rather than coming in.
The number is easy to calculate and almost nobody does it. Practice management systems will happily show you charges, collections and today’s deposit, but the share of your receivable that has gone stale is something you have to pull yourself. It takes about two minutes.
Why the oldest bucket is the one that matters
Age is the single best predictor of whether a dollar ever arrives. A claim at 30 days is normal business. The same claim at 150 days is usually not slow — it is stuck, and often it is already lost.
What’s actually sitting in that bucket is four different problems wearing the same costume:
| What it is | Recoverable? |
|---|---|
| Claims that blew a timely-filing window | No. These are gone, not late. No amount of follow-up recovers them. |
| Denials nobody appealed | Often — but only inside the payer’s appeal window. |
| Rejections never rebilled | Yes. The claim never reached the payer at all, so nothing is pending. |
| Patient balances with no follow-up | Partly, and it declines steeply with age. |
On an aging report all four look identical: a name, a payer, a number, a column. That is precisely why the bucket grows. Without separating them, the work has no obvious starting point, so it doesn’t get started.
Calculating your own number
Run an A/R Aging Summary as of today, then divide the 121+ day total by total A/R. Use the summary totals, not the detail report. One number over another number.
Aging start date. Some reports age from the date the claim was billed, others from the date of service. If the two are weeks apart in your practice — and after a system migration they often are — the same receivable can look materially healthier or worse depending on which report you happened to run.
Unapplied payments. When payments have been received but never applied to a patient account, the ledger can no longer show what was actually collected or what is genuinely still owed. Your total A/R is then wrong, and so is any percentage built on it. If you have a meaningful pile of unapplied payments, reconcile those first.
What an unhealthy number looks like
76%
Share of total receivable sitting past 120 days, against a 10–15% benchmark. De-identified, unaudited, from the practice’s own aging report.
That is not a collections problem in the usual sense. Nothing about it says the front desk is failing to chase claims. It says a very large share of the receivable has been carried forward, month after month, without anyone deciding what each piece actually is — recoverable, appealable, or already lost.
The uncomfortable part of a number like this is that some of it is fiction. A receivable nobody will ever pay is not an asset; it is a line item making the practice look wealthier than it is.
Where to start — in order
Not oldest first. Deadline first, because deadlines are the only part of this that keeps getting worse while you decide.
| # | Work this | Why here |
|---|---|---|
| 1 | Anything near a filing or appeal deadline | Sort by date of service and find what is about to age out. The only category where waiting a week changes the answer. |
| 2 | Denials with a real appeal path | Group by denial reason, not by patient. One fixable reason usually explains a cluster, and one corrected process stops the next cluster forming. |
| 3 | Large patient balances | Start at the top by dollar amount. A handful of accounts typically carries most of the patient-side balance. |
| 4 | Write off what is genuinely gone | Then recalculate. The percentage only becomes a useful management number once it stops including money that was never coming. |
Worked in that order, the bucket shrinks for two separate reasons: some of it gets collected, and some of it stops pretending to be collectable. Both are improvements.
The one thing worth doing this week
Pull the A/R Aging Summary and calculate the single percentage. If it comes back near 10–15%, your collections process is working and you can stop reading about this. If it comes back at 40, 60, 76 — the problem isn’t effort, and more chasing won’t fix it. It is that nobody has yet sorted the pile into recoverable and gone.
Practice A is an independent chiropractic practice analyzed by Belle Curve Insights under an unpaid pilot engagement. It is co-founded by Darin Stokke, who is also Chief Strategy Officer of Belle Curve Insights — not an arm’s-length client. All figures are de-identified, contain no patient-level information, and are unaudited.