Payer mix, days in AR and provider pay, every month

Healthcare accounting that tracks every payer and every location.

Know what each insurer owes you, how fast it pays and what each location earns. For medical practices and clinics earning $1M to $50M, we match every deposit to its claims, track days in AR and denials by payer, tie provider pay to collections and close your books by mid-month. A licensed CPA reviews it all.

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By payerdays in AR and denials

Monthlydeposits matched to claims

CPAsign-off on every report

Where healthcare revenue gets lost

Six places money leaks between the visit and the deposit.

Pick a moment to see what usually happens, and what happens when your books are run for a medical practice.

Fix the leak that costs you most

UsuallyYour staff was already paid for the visit, but the insurer rejected the claim over a small error. The labor cost is spent and the revenue is gone.

With AceCPAsWe track denied claims by payer and reason every month, next to the payroll cost of those visits, so you see the dollar loss right away.

Insurance receivables

How should a medical practice track insurance receivables?

Track insurance receivables by payer, not as one AR balance. Each month, match every deposit to its remittance (ERA), age open claims by insurer, and report days in AR, AR over 90 days, denials and recoupments for each payer. Book revenue at the amount you expect to collect, after contractual adjustments, so the balance sheet stays honest.

What slow payers cost you in cash

Move the sliders. Every day of AR is a day of collections sitting with insurers instead of in your bank.

Average monthly collections$480,000

Days in AR today42 days

Target used here35 days

Common range30 to 40 days

Illustrative. Days in AR = AR balance / average daily collections over the last 90 days. Your target depends on your specialty and payer mix.

The math, step by step

1. Daily collections$16,000Monthly / 30

2. Cash in AR$672,000Daily x days in AR

3. Cash to free$112,000At 35 days

$112,000 stuck with payersEach day of AR holds $16,000 of your cash. Getting from 42 to 35 days puts $112,000 back in your bank, once, without a single new patient.

Receivables by insurer, as of month end. Click a payer to see its math.Illustrative

Payer	Net revenue, 90 days	Mix	Per day	AR balance	Days in AR	Over 90 days	Denial rate
Medicare	$360,000	25%	$4,000	$96,000	24	$3,840	4%
Medicare Advantage	$216,000	15%	$2,400	$110,400	46	$15,456	11%
Commercial plans	$576,000	40%	$6,400	$243,200	38	$26,752	7%
Medicaid managed care	$180,000	12.5%	$2,000	$124,000	62	$31,000	13%
Patient balances	$108,000	7.5%	$1,200	$98,400	82	$39,360	n/a
Total, 5 payers	$1,440,000	100%	$16,000	$672,000	42	$116,408

On the balance sheet

Patient and insurance AR$672,000

Over 90 days$116,408 (17%)

Days in AR, all payers42

Cash freed at 35 days$112,000

AR is booked at the amount you expect to collect, after contractual adjustments, so this schedule ties to your balance sheet every month.

Built on your billing and payroll

What our healthcare accounting services do every month.

Clean books and reconciliation built on top of the billing and payroll systems you already use, reviewed by a licensed CPA, with your financials and payer report on your desk by mid-month.

Every month Visits, claims, payroll and deposits, tied out. Every hour worked, every claim and every deposit tied together, so you see where money moves and where it stops. Each deposit matched to its remittanceUnbilled visits flagged to billingPayroll hours tied to billed visitsReviewed by a licensed CPA Get my free AR review

01 · Denials and takebacksDenials and recoupments tracked by payer. Write-offs never surprise your books.

02 · RevenueRevenue booked at what you will collect.

03 · Provider payProvider pay tied to collections. Labor cost measured against what each provider collects.

04 · Payer mix and marginProfit by payer, program and location. Know which services and payers earn the most.

05 · Unbilled workUnbilled visits caught early.

06 · Cash forecastA 13-week forecast built on payer speed.

07 · Lenders and audits Books that hold up to a lender review or an audit.

Where our work stops. We do not submit claims, chase authorizations or appeal denials. Your billing team or billing company does that, and does it better than an outside accounting firm. We build the financial layer on top and show them, in dollars, where money is stuck.

See how we work with your billing team

Reports every month

What lands on your desk each month.

Every open dollar, by insurer and age.

Receivables split by payer into 0 to 30, 31 to 60, 61 to 90 and over 90 days, so your billing team knows which claims to work first.

See these with your numbers

AR aging by payer, month endIllustrative

Payer	0 to 30	31 to 60	61 to 90	Over 90	Total
Medicare	$71,885	$16,589	$3,686	$3,840	$96,000
Medicare Advantage	$52,219	$28,483	$14,242	$15,456	$110,400
Commercial plans	$129,869	$60,605	$25,974	$26,752	$243,200
Medicaid managed care	$37,200	$30,690	$25,110	$31,000	$124,000
Patient balances	$17,712	$17,712	$23,616	$39,360	$98,400
Total	$308,885	$154,079	$92,628	$116,408	$672,000

17% of AR is over 90 days. Medicaid managed care and patient balances hold most of it, so they go to the top of the billing team's list.

Provider pay vs collections, North clinic, last monthIllustrative

Provider	Collections	Pay	Pay to collections
Physician A	$60,000	$28,200	47%
Physician B	$57,000	$27,360	48%
Physician C	$55,000	$25,850	47%
Physician D	$52,000	$24,960	48%
Physician E, first year	$40,000	$25,000	62.5%
Nurse practitioner	$36,000	$10,800	30%
Total	$300,000	$142,170	47.4%

Physician E is on a first-year guarantee. Pay runs ahead of collections until production ramps, and the gap is tracked monthly.

Margin by location, last monthIllustrative

	North	South	Total
Collections	$300,000	$180,000	$480,000
Provider pay	($142,170)	($88,600)	($230,770)
Staff payroll	($72,000)	($46,800)	($118,800)
Rent and occupancy	($21,000)	($18,000)	($39,000)
Supplies and other	($27,000)	($16,200)	($43,200)
Margin	$37,830 (12.6%)	$10,400 (5.8%)	$48,230 (10%)

South clinic is under 10%. Provider pay is 49.2% of its collections against 47.4% at North, so it gets a closer look this month.

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Questions

Medical practice accounting questions, answered.

Still have a question? Call (336) 203-7399 or email info@acecpas.com. Monday to Friday, 9 AM to 6 PM ET.

Reviewed by Mubarak Shah, CPA · Updated November 2026

Ask a CPA directly

What is days in accounts receivable for a medical practice?

Days in accounts receivable (days in AR) measures how long it takes, on average, to collect what you are owed. Divide your AR balance by your average daily collections over the last 90 days. Many well-run practices stay between 30 and 40 days. We report it every month for the practice and for each payer, because one slow insurer can hide inside a healthy average.

What is payer mix, and why does it matter?

Payer mix is the share of your revenue from each source: Medicare, Medicare Advantage, commercial plans, Medicaid and patients. Each pays at different rates and at different speeds, so your mix drives both margin and cash timing. We report revenue, days in AR and denials by payer, so a shift in mix shows up the month it happens.

What is a good net collection rate?

Net collection rate is what you collected divided by what you were owed after contractual adjustments (charges less the discounts your payer contracts require). Many well-run practices collect 95% or more. A lower rate usually points to denials that were never reworked, timely filing write-offs or patient balances left uncollected.

Do you do medical billing or submit claims?

No. Claim submission, prior authorizations and denial appeals stay with your billing team or billing company. We build the financial layer on top: every deposit matched to its remittance, denials and recoupments tracked by payer, and reports that show your billing team where money is stuck.

How do you handle provider compensation tied to collections?

Each month we pull every provider's collections from the remittance data and apply the pay formula in their contract, such as a percentage of collections, a base plus bonus or a first-year guarantee. You see provider pay next to collections by provider and location, so you know whether each contract still works.

Do you need access to patient information?

We sign a business associate agreement (BAA) before any work starts and use secure file sharing. Most of our work runs on remittance data and summary reports, not patient charts. Your EHR and practice management system stay with your team.

Which accounting software do you work in?

We work inside the QuickBooks Online file your practice already uses, and read reports from your practice management or billing system and your payroll provider. Your staff keeps its routine. If you are still on desktop software, we move your data during setup at no extra charge.

How much do healthcare accounting services cost?

It depends on the number of providers and locations, your payers, transaction volume, payroll and how much of the bookkeeping we run. After a free 30-minute review you get a fixed-fee proposal with one monthly fee, before any work starts. No hourly billing.

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