When an agency tells us their AR days are too high, the assumption is usually that payers are slow. Sometimes they are. More often, the delay is upstream and internal, which is good news, because internal problems are the ones you can fix without anyone's permission.
Break the number apart
Stop measuring one figure. Measure four.
- Discharge or period end to chart complete
- Chart complete to coded
- Coded to claim submitted
- Claim submitted to cash posted
In most of the agencies we have onboarded, the first two stages account for more elapsed time than the payer stage does. Visit notes sit unsigned. Orders wait on a physician's office. Coding waits on a query nobody chased.
The three cheapest interventions
None of these need new software.
- A daily unsigned-note list that goes to supervisors rather than to a shared inbox
- A named person who owns verbal order signature follow-up, with a call schedule
- A 24-hour service level on coder queries, agreed with clinical leadership in advance
Then look at denials by reason, not by count
Twenty denials for the same missing element is one problem. Twenty denials for twenty reasons is a different problem entirely, and it usually points at intake rather than billing.
One agency we work with went from 47 AR days to 22 in a quarter. Nothing about their payer mix changed. What changed was that unsigned notes stopped sitting for nine days.
Gravita RCM Desk · 21 April 2026
