Healthy A/R Benchmarks for Eye Care Practices in the USA
A/R aging shows how long claims have been unpaid. For eye care practices in the USA, a healthy spread looks like the table below. When more of the balance sits in the older buckets, cash is slowing down and some of it will never arrive.
| Aging bucket | Target share of total A/R | What it means |
|---|---|---|
| 0 to 30 days | About 65% | Normal processing time |
| 31 to 60 days | About 18% | Slow payers and first follow-up |
| 61 to 90 days | About 9% | Needs active follow-up |
| 91 to 120 days | Under 5% | Denied, lost or stuck claims |
| Over 120 days | Around 3% | High risk of permanent loss |
These targets are a guide. Surgical and injection-heavy practices often carry more in the 31 to 60 day bucket because of drug and surgical claim review.
Our A/R Recovery Process
An A/R recovery project starts with a full aging report and ends with every open claim paid, appealed or closed with a reason. We work it in five steps.
- Stratify. Claims sorted by payer, dollar value and days left before the filing or appeal limit.
- Check status. Claim status checked through payer portals and 276/277 transactions, with calls where portals give no answer.
- Act. Rejected claims corrected and resubmitted, denied claims appealed, missing records sent.
- Follow up. Each claim revisited every 10 to 14 days until it resolves.
- Close out. Uncollectable balances written off with a documented reason and approval from your practice.
Timely Filing Deadlines That Limit A/R Recovery
Every payer sets a filing limit, and a claim filed late is usually lost for good. Medicare allows 12 months from the date of service. Texas Medicaid allows 95 days. Many commercial plans allow 90 to 180 days, and Davis Vision allows 60 days. We sort aged claims by days left to the deadline, not only by age, so claims about to expire are filed first.
When a claim looks late, we search for proof of timely filing, such as clearinghouse acceptance reports or earlier payer correspondence. Proof of an on-time first submission often reopens a claim that looked lost.
Credit Balances and Refunds in Your A/R
A/R clean-up is not only about money owed to you. Credit balances, where the practice has been paid more than it is owed, create compliance risk. Under federal law, an identified Medicare overpayment is due back within 60 days of identification. We review credit balances, confirm the true overpayments and prepare refunds or offsets with your approval.
Why Does Ophthalmology A/R Age?
A/R ages for a small set of reasons, and most trace back to earlier steps in the revenue cycle.
- Denials that were never worked because no one owned them
- Claims rejected at the clearinghouse and never corrected
- Secondary claims never sent after the primary paid
- Drug claims held for records the payer requested
- Patient balances left in insurance A/R after the payer finished
Once old A/R is cleaned up, denial management and daily payment posting keep it from building again. See where your A/R stands with a free ophthalmology billing audit.