Reading days in A/R: what good looks like by specialty

What the number actually measures

Days in A/R is calculated as the total accounts-receivable balance divided by the average daily charges over a trailing window, usually ninety days. It expresses, in days, how long it takes the practice to convert work into cash. A lower number is better. The number is sensitive to billing cadence; practices that hold claims for batch submission inflate it artificially. It is also sensitive to write-off policy; practices that aggressively write off old balances flatter it.

The metric should be read alongside two siblings. Days in A/R over ninety, the percentage of receivables aged more than ninety days, is a better measure of work-discipline because old A/R is the hardest to collect. And cash-to-net-collections ratio, the percentage of net-collectible revenue actually collected, is the better measure of whether the dollars are landing.

Specialty benchmarks

The MGMA Cost Survey publishes days-in-A/R medians by specialty annually. The numbers below are directional and from recent surveys; specific practices can hit lower depending on payer mix.

Primary care and family medicine: median twenty-eight to thirty-two days. Top-quartile under twenty-five. This is the specialty with the fastest cycle because the encounter is short, the coding is standardized, and the payer mix skews toward commercial and Medicare with predictable payment timelines.

Internal medicine: median thirty-two to thirty-six days. Slightly slower than primary care because of higher complexity-of-care coding and a higher share of preventive services that hit different benefit categories.

Cardiology, gastroenterology, dermatology: median thirty-five to forty days. The procedural overlay drives both the higher revenue and the longer cycle, because procedural authorizations and follow-up coding cycles add days.

Orthopedic surgery, general surgery, surgical oncology: median forty-two to fifty days. Long cycles driven by pre-auth complexity, longer claims-adjudication times on high-dollar procedures, and the bundled-payment structures that delay component reconciliation.

Behavioral health and psychiatry: median thirty-eight to forty-five days. Driven by the carve-out plans, behavioral-health vendors, and the higher denial rate that this specialty carries.

Pediatrics: median thirty to thirty-four days. Comparable to primary care but with a stronger Medicaid component in many markets, which can pull the number higher in states with slower Medicaid payment cycles.

What drives the number

Three operational levers control days in A/R. The clean-claim rate at first submission is the largest single driver. Practices with ninety-five percent or higher first-pass clean rates run twenty to twenty-five percent faster than practices in the eighty-five percent range. The math is direct: every claim that bounces back for correction is a claim that just added ten to fifteen days to its individual cycle.

The denial-work cadence is the second lever. Denials worked within a week of receipt resolve roughly twice as fast as denials worked at thirty days, because the supporting documentation is fresh, the patient context is recoverable, and the payer's adjudicator memory of the claim is still active. Practices that batch denial-work to weekly or biweekly cadences add real time to the cycle.

Payment posting discipline is the third lever, and it is the one most administrators underestimate. Posting delays show up as inflated A/R because the cash is in the account but not yet reconciled against the claim. A practice that posts payments same-day will read three to five days lower on the metric than a practice that posts on a three-day lag, with no actual change in underlying performance.

What it takes to move the number

Moving days in A/R is unglamorous work. It is not a single project. It is the cumulative effect of running the eligibility, authorization, coding, submission, denial, and posting functions on consistent daily cadences with clear accountability. The practices that move the number five to ten days in a year are not the practices that bought a new tool. They are the practices that staffed a dedicated team to run the cycle, gave that team a single point of accountability, and reviewed the metrics weekly.

An external operator who runs the cycle as a program rather than a series of vendor relationships will usually move the number faster than an in-house build, because the program is already past the learning curve. The Premier Medsolutions RCM program reports weekly on days in A/R, denial rate, clean-claim rate, and cash-to-net-collections, against the specialty benchmark for the practice. The first thirty days typically reveal the levers; the first ninety days typically move the number.