The over-90 column gets smaller once someone owns it on a set schedule. Split it into insurance and patient balances, work the largest accounts first each week, and pass insurance items to your billing team with clear notes. Upstream, accurate estimates, collection at checkout and same-day payment posting keep new balances from aging.
Every practice carries some old receivables. The real question is whether the total is shrinking or creeping up. When it creeps up, the cause is seldom one difficult carrier or patient. More often the list has no owner and gets worked on slow afternoons, which a busy practice doesn't have many of.
Why do balances end up past 90 days?
A handful of causes account for most of it.
- The estimate was off. Benefits weren't verified or a frequency limit was missed, so the patient owes more than they expected.
- Nothing was collected at checkout. A statement went out instead, and statements are easy to set aside.
- The claim didn't go out cleanly. It sat in a batch, lacked an attachment or was rejected without anyone noticing.
- Payments weren't posted. The money arrived, but the ledger still shows a balance, which makes the report harder to trust.
- The list has no owner. Everyone assumes someone else is following up.
Since each cause has its own fix, a close look at the report is worth doing before anyone picks up the phone.
How should the aging report be read?
Run the aging report from your practice software and look at the insurance and patient portions separately. They call for different routines and often different people.
| Bucket | Insurance portion | Patient portion | What it usually means |
|---|---|---|---|
| 0–30 days | Normal claims in process | Recent visits, statements going out | Healthy if checkout collection is strong |
| 31–60 days | Claims that need a status check | No response to the first statement | First follow-up is due |
| 61–90 days | Delayed or denied claims | Balances that need a phone call | Last easy window to collect |
| Over 90 days | Denials, missing information, claims nobody followed up | Disputed, forgotten or unaffordable balances | Needs an owner, a deadline and a decision |
Credit balances, where the practice owes a patient or carrier, distort the totals and belong in the same cleanup.
Sorting the over-90 list by balance usually shows that a small number of accounts hold most of the dollars. Those are where the first week's time goes.
What does the front-desk routine look like?
Most of the over-90 problem is prevented at the front desk, long before an account ages.
Every day
- Verify benefits before each appointment, including frequency limits and remaining maximums
- Give the patient a written estimate before treatment and collect their estimated portion at checkout
- Post all insurance and patient payments the same day
- Confirm the day's claims went out, and flag rejections to the billing team or vendor
Once a week, in a set block
- Run the aging report and note the over-90 total
- Work patient balances from largest to smallest by phone, then text or email, then statement, following your financial policy
- Offer a written payment arrangement where the policy allows
- Send insurance items to the billing team or vendor with notes on what's missing, what the carrier said last and what you need back
- Log each account touched, with the result and the next follow-up date
A weekly block on the schedule, treated like an appointment, gets far more done than good intentions. Two protected hours on a Thursday afternoon is plenty for most solo practices.
Who owns each part?
Writing down who does what, and sharing it with the team, settles most of the confusion.
| Role | Owns |
|---|---|
| Front desk | Verification, estimates, collecting at checkout, posting payments, working patient balances, logging follow-up |
| Billing team or vendor | Submitting claims, working rejections and denials, appeals and carrier calls |
| Owner | The financial policy, approving write-offs and payment plans outside the policy, a monthly review |
| Molar + Margin | Setting up the routine, scripts and reporting, and reviewing the numbers with you each month |
Molar + Margin doesn't file claims, write appeals or call carriers. Our part is building the system your team and billing vendor follow, along with the reporting that shows whether it's working.
What's worth reviewing each month?
About 20 minutes is enough. These are the items to look at:
- The over-90 total against last month, split into insurance and patient
- The number of accounts over 90 as well as the dollars
- How much of each day's patient portion was collected at checkout
- The largest over-90 accounts and the next step on each
- Accounts ready for a decision on a payment plan, write-off or collection agency, under your policy
If the total hasn't moved after a couple of months of steady work, the cause is usually upstream in estimates or checkout rather than in the follow-up.
When does a balance get written off or sent to collections?
Your financial policy is the right place to settle this, well before you're looking at a particular patient's account. It can set the number of contacts, the time frame and who approves a write-off or a referral to an outside agency. Small balances can cost more in staff time than they bring in, while larger ones warrant the full routine first.
Have your attorney review the financial policy and any collection language. Courteous conversations matter here too, since a patient who feels respected is more likely to pay and to come back.
If the over-90 column keeps growing and nobody quite owns it, we'd be happy to help you find out why and set up a routine your team can keep. Molar + Margin offers a fixed-fee Receivables Review, and in a retainer the AR routine is often one of the first changes in month one. A complimentary 30-minute First Look is a good first step. We're based in South Florida and work with practices remotely across the U.S.; you can reach us at jana@molarandmargin.com or 561-685-4859.