More than four in 10 (43%) medical group leaders report their practice’s days in accounts receivable (A/R) are about the same as a year ago, according to a July 28, 2026, MGMA Stat poll. Nearly one-third (32%) said days in A/R are higher, while 22% reported a decrease, and 3% were unsure. The poll had 203 applicable responses.

Measuring slow payments in a tight-margin year

Days in A/R turn a practice’s receivables into a measure of time: total A/R divided by average daily charges, showing how many days pass between the date of service and payment. This metric matters as most medical groups continue to report increasing operating costs, while the June 30 poll found the revenue picture split — 47% of groups up, 36% down. Payroll and rent come due on schedule whether or not claims have cleared, so every added day of A/R is cash the practice cannot use for current expenses.

Our Jan. 6 MGMA Stat poll showed where many practices lose this time: 48% of leaders named denials and appeals their practice’s largest source of revenue leakage, compared with 23% who cited front-end issues. Each denied claim restarts the collection clock and pushes the balance into older aging buckets while staff rework and resubmit it. MGMA benchmarking puts first-submission denials at 7% to 8% across the past four years — steady but not optimized: our 2025 Financials and Operations data report suggests practices can push the rate below 5% with targeted process fixes.

What you told us

The open-ended responses show practices being pulled in opposite directions. Among respondents whose days in A/R increased, payer behavior was the dominant theme. Leaders cited slower payment, initial denials, downcoding, requests for medical records, prepayment audits and lengthy appeals or claim-reprocessing timelines. Several answers were as direct as “payer delays” and “increased initial denials.” One respondent described insurers “denying claims without reason,” while another pointed to downcoded claims that required appeals before the practice could collect the full amount.

Internal disruptions added to those delays. Practices reported vacancies and turnover in billing departments, difficulty replacing experienced A/R staff, medical leave, credentialing delays for new providers and interruptions caused by changing billing companies, EHRs or practice management systems. One system transition reportedly delayed billing for two months because of interface problems.

Respondents who lowered days in A/R described deliberate operational changes rather than a single quick fix. Common answers included adding staff, installing new billing leadership, strengthening denial management, closing notes sooner, improving front-desk registration and collections, and using new software or AI-assisted billing tools. Some practices brought revenue cycle work back in-house; others improved results after outsourcing or changing vendors. One respondent reported an RCM overhaul that reduced days in A/R from 67 to less than 34.

The “about the same” responses show that a flat result can still require considerable work. Several leaders said clean claims, next-day submission, experienced staff, consistent denial follow-up and time-of-service collections were helping offset payer delays, documentation requests and growing patient balances. One practice kept insurance A/R within 28 days, but self-pay balances raised its overall result to 32 days.

Finding where your payments slow down

The responses reinforce why practice leaders should look beyond the total number. Stable days in A/R may conceal faster claim submission and better follow-up on one side, while payer rework, staffing shortages or patient balances add days on the other.

The first question is who controls the delay. Payer-side problems include slow adjudication, denials, downcoding, medical-record requests and appeal processing. Practices may not be able to eliminate those behaviors, but they can track them by payer, escalate recurring problems and bring the results into contract discussions. Practice-side delays are more directly addressable: eligibility checks, registration accuracy, unsigned encounters, charge-posting lag, denial follow-up and patient collection procedures.

The 2025 MGMA DataDive Financials and Operations data report shows a wide gap in A/R aging. In 2024, physician-owned practices increased the share of A/R in the 0–30-day bucket by roughly 2 to nearly 7 percentage points and kept balances 120+ days old mostly flat. Hospital- and IDS-owned groups went the other way: their 0–30-day share fell by double digits, while the 120-plus-day share rose 9.5 to 15.9 points. The cost showed up in bad debt. Hospital-owned groups reported $43,073 per FTE physician in nonsurgical specialties and $48,337 in surgical specialties; bad debt declined over five years in independent practices.

Collecting more before the patient leaves reduces the balances staff must chase later. In 2024, practices collected 72% of copayments at the time of service but only about 27% of other patient-due balances. Uncollected amounts then move to statements, calls and older A/R. An Oct. 21, 2025, MGMA Stat poll found 66% of groups holding or improving patient balance collections. Groups that improved most often cited clearer estimates, stronger time-of-service collection and staff accountability.

Four checks for the revenue cycle team

Start with four checks. Run A/R aging by payer, not only in total, to identify slow payers before contract talks. Measure the time from the visit to a submitted claim: set expectations for clinicians to close encounters within 72 hours and for staff to post charges within two days, compared with the three- to seven-day lag seen across the sector. Work denials daily, starting with high-dollar claims and the nearest appeal deadlines, and review the five most common denial codes for preventable causes. At check-in, give staff a standard way to explain estimates and request patient-responsibility amounts before the patient leaves.

As budget and payer-contract season begins, bring payer-level aging reports to the table. They show which payers are consistently slow, how much A/R is tied up and how long the practice has been waiting.

With 43% of practices holding steady and nearly one-third moving backward, these results do not point to broad improvement. Instead, they show many revenue cycle teams working harder simply to keep A/R from slipping. The question for the year ahead is whether better staffing, cleaner claims and faster follow-up can stay ahead of payer delays and rising patient balances.

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Notes

1. Harrop C. “Operating costs keep climbing for medical practices in 2026.” MGMA. June 2026. https://www.mgma.com/mgma-stat/operating-costs-keep-climbing-for-medical-practices-in-2026
2. Harrop C. “Revenue growth narrows as costs climb: the 2026 squeeze on medical practices.” MGMA. July 2, 2026. https://www.mgma.com/mgma-stat/revenue-growth-narrows-as-costs-climb-2026-squeeze
3. Harrop C. “Detecting and fixing leaks across the revenue cycle.” MGMA. Jan. 7, 2026. https://www.mgma.com/mgma-stat/detecting-and-fixing-leaks-across-the-revenue-cycle
4. Harrop C. “Patient balance collection: What’s moving the numbers and how to get ahead.” MGMA. Oct. 22, 2025. https://www.mgma.com/mgma-stat/patient-balance-collection-whats-moving-the-numbers
5. MGMA. “Margin in Motion: Revenue-Cost Realities and Staffing for Yield.” MGMA DataDive Financials and Operations data report, September 2025. https://www.mgma.com/2025-financials-and-operations