How to Reduce Days in Accounts Receivable for Your OB/GYN Practice

Days in accounts receivable (A/R) measures how long it takes, on average, to turn charges into cash. When it creeps upward, the practice is effectively lending money to payers and patients — and the longer claims sit, the less likely they are to be collected at all.

Here are ten practical steps to bring days in A/R down in an OB/GYN practice, starting with the ones that usually make the biggest difference.

First, measure it the same way every month

Days in A/R = Total A/R ÷ Average daily gross charges

Use the last three months of gross charges divided by the number of days in those months for average daily charges. Track it alongside A/R over 90 days as a percentage of total A/R, which shows how much is at risk. See OB/GYN billing KPIs.

1. Cut charge lag

Every day between the visit and the claim adds a day to A/R. Common causes in OB/GYN: unsigned notes, coding backlogs, and surgical claims waiting for operative or pathology reports.

Fix: set a target (for example, charges entered within two business days for office visits), report charge lag by provider, and keep a short weekly list of surgical claims waiting on documentation.

2. Submit claims daily

Batching claims weekly adds days to A/R for no reason. Submit clean claims every business day, and fix clearinghouse rejections the same day.

3. Get claims right the first time

Rework is the biggest single driver of slow payment. Improve first-pass acceptance with:

• Eligibility verification before visits
• Claim scrubber rules for your most common rejections
• OB/GYN-specific edits — Z37 on delivery claims, Z34 with O codes, hysterectomy weight tiers, LARC device codes

4. Work denials within 48 hours

A denial that sits for a month adds a month to A/R. Post remits promptly and triage denials within two business days: correct, reconsider or appeal. See denial management and our list of top OB/GYN denial reasons.

5. Track A/R by payer, not just in total

A blended A/R figure can hide a single problem payer. Break A/R down by payer and age bucket. Often a large share of aged A/R sits with just a few payers — which makes the problem actionable: a payer-specific issue (credentialing, a policy change, a processing error) can be escalated with that payer.

6. Follow up before claims go quiet

Set follow-up rules: if a claim hasn't been paid or denied within a payer's typical processing time, check status. Don't wait for 90 days. Use payer portals and claim status transactions to find claims that were never received.

7. Don't let global maternity claims sit unmonitored

Obstetric revenue behaves differently:

• Unbilled care doesn't show in A/R. Through 2026, routine obstetric care is billed after delivery, so it isn't in A/R until then. Track open pregnancies and unbilled deliveries separately.
• Delivery claims are often held until the postpartum visit. Know each payer's billing policy and timely-filing limit, and submit as early as allowed.
• Split care stalls when nobody bills antepartum components after a transfer.

See global maternity billing.

8. Fix credentialing gaps quickly

Claims for providers who aren't yet effective with a payer sit unpaid or deny. Track enrollment status for every provider and payer, and hold or route claims accordingly. See credentialing.

9. Collect patient responsibility up front

Patient balances age faster than insurance balances. Collect copays and known deductibles at the visit, provide cost estimates for surgery and maternity care, offer online and text-to-pay options, and send clear statements promptly.

10. Clean up old A/R deliberately

Aged A/R inflates days in A/R and hides real problems. Review claims over 90 days:

• Still recoverable? Work them in order of value and deadline.
• Past timely filing or appeal limits? Document the reason and adjust off with the correct adjustment code — so your reports show why revenue was lost.
• Credit balances? Resolve them; they distort A/R in the other direction.

A weekly A/R routine

Getting ready for 2027

When the global maternity package ends on January 1, 2027, prenatal visits will be billed per encounter — so obstetric care will start showing up in A/R throughout the pregnancy instead of after delivery. Expect your A/R mix and days in A/R to shift, and set a baseline now so you can tell what changed. See the 2027 maternity transition guide.

Key takeaways

• Measure days in A/R and A/R over 90 days consistently.
• Charge lag, first-pass errors and slow denial work drive most A/R problems.
• Break A/R down by payer and fix payer-specific issues.
• Track obstetric revenue that isn't yet in A/R.

Signs your A/R needs immediate attention

• Days in A/R rising for three months in a row
• A/R over 90 days growing as a share of total A/R
• One payer holding a disproportionate share of aged A/R
• Denials piling up without being worked
• Claims you can't find in the payer's system
• Deliveries from more than a month ago not yet billed

Any one of these is worth a closer look; two or more usually mean a process has broken down.

Want help bringing A/R down?

Our revenue cycle management service includes daily claim work, 48-hour denial triage and monthly A/R reporting. Send us a WhatsApp message for a free review of your A/R aging.