A July 30 MGMA Stat report delivered a stat that looks like good news: days in accounts receivable held steady for most practices, with 43 percent of medical group leaders reporting AR days about the same as a year ago. But 32 percent reported days in AR higher, and the leaders seeing increases attributed them to slower payer payments, initial denials, downcoding, medical records requests, prepayment audits, and lengthy appeals timelines.
Steady AR in a year when payers got faster at adjudicating, expanded prior auth, and layered on audits is not stability. It is a team running harder to stay in place. The practices holding flat are the ones whose staff absorbed the payer-side friction - more portal checks, more calls, more rework - without letting the backlog show. That is an expensive way to define "steady."
What the benchmark actually says
The same MGMA report offers the useful comparator: first-submission denials have sat at 7 to 8 percent across the past four years, and MGMA's benchmarking data suggests practices can push below 5 percent with targeted process fixes. Two lessons hide in that range:
- Flat is the default. Four years of 7 to 8 percent means the median practice is not improving. Whatever the payer environment does next, unmanaged processes stay where they are.
- The gap between 8 and 5 percent is operational, not clinical. A three-point denial-rate improvement on a typical practice's claim volume is pure recovered cash and avoided rework - no payer negotiation required.
The math of a drifting AR
Days in AR is the most expensive metric to be complacent about because it compounds. Each additional day of AR is cash delayed across your entire open claim inventory. For a practice billing $100,000 a month, five extra days of AR is roughly $16,000 of working capital borrowed at zero interest to fund payer inefficiency. Add the labor cost of chasing aged claims - which rises per claim as they age - and the "steady" state quietly taxes both balance sheet and payroll.
The leaders MGMA surveyed named the causes precisely: not staff turnover or patient balances, but payer-side delay and denial mechanics. Those are mechanical, documentable, follow-up-shaped problems. Which means they respond to systematic follow-up the same way they always have - the constraint is hours, not knowledge.
Moving AR is a queue-discipline problem
Practices that actually improve AR days tend to change one thing: nothing in the queue waits on memory.
- Every open claim has a next action and a date, assigned automatically, so nothing ages because someone forgot it.
- Payer statuses are checked daily across portals, not spot-checked weekly by whoever has a spare hour.
- Denials enter their own queue with deadlines the day they appear, because denial aging is the fastest route from "steady" to "higher."
- Aged AR gets worked by pattern - payer, code, age bucket - rather than alphabetically by patient name.
A practical warning for teams planning the fix: do not launch it as a one-time cleanup project. Aged AR blitzes feel productive and reliably backslide, because the daily queue discipline that prevented the aging was never installed. Improvement that lasts is boring - the same checks, every day, assigned the same way - which is precisely the kind of work software does better than staff working overtime. Run the cleanup if you need one, but judge the effort by whether next quarter's AR curve bends, not by how many claims the blitz touched.
MGMA's July benchmarking puts first-submission denials at 7 to 8 percent for four straight years, with practices able to push below 5 percent through targeted process fixes. The 48 percent of leaders who named denials their largest revenue leak in January are, in effect, describing the same gap from the other side.
The takeaway
Holding AR steady while payers accelerate is a soft decline. The 32 percent of practices whose AR days rose are simply the ones whose absorption capacity ran out first. The fix is not more hours - it is a queue that never relies on memory: daily status checks, automatic next actions, and denials worked to deadlines. That is the discipline QHB's agents run every day, and it is why we measure ourselves on the only AR number that matters: fewer days, not the same days.