What is payer accounts receivable aging?
It is the report that shows how long each receivable has been open, grouped by day ranges and by debtor. In a Brazilian hospital, the main debtor is the health plan (operadora de plano de saúde, a company registered with ANS), so aging is built by health plan and, when needed, by contract or product.
Aging is a snapshot on a report date, usually month-end. The pillar guide Revenue cycle metrics shows where aging fits in the hospital dashboard, next to days in A/R, bad debt and the collection rate.
Two hospitals can have the same days in A/R and very different portfolios; only aging shows whether the balance sits in the first 30 days or is concentrated in six-month-old invoices from one health plan.
Hospital aging is not the aging of an ordinary business
Three features of a Brazilian hospital claim change how the report is built.
The due date comes from the contract. Lei 9.656/1998 (Law 9,656/1998, the health plans law) requires the contract between health plan and provider to state billing and payment terms and procedures (art. 17-A, § 2) [5]. RN 503/2022 (Normative Resolution 503/2022), which governs these contracts, sets no number of days for payment [6]. Each invoice's due date therefore depends on each contract's calendar.
Part of the balance is denial. The claim analysis remittance, a message in the TISS standard (Troca de Informações na Saúde Suplementar, the mandatory electronic data interchange standard), reports what was paid and what was denied on each claim [7]. A denied amount may be under appeal or may have been accepted; mixing the two in one bucket hides the problem. The guide Claim analysis and payment remittance explains how to read it.
A response does not always arrive. In its Denial Indicators Panel, ANS measures the share of claims with nothing paid or denied 30 days after the billing protocol date [4]. Such a claim is neither a denial nor a late payment: it is a claim with no response.
Which date should start the aging clock?
The start date defines what aging measures. A Brazilian hospital has four candidates:
| Start date | What aging measures | When to use it |
|---|---|---|
| Discharge or date of service | Total time since care was delivered, including internal delay | Executive view; comparison with HFMA, which ages from discharge (inpatient) or date of service (outpatient) [8] |
| Batch submission (TISS protocol) | Time with the health plan, excluding internal delay | Collections; the protocol number proves the batch was received [7] |
| Contractual due date | Real delay against what was agreed | Collection cadence and talks with the health plan |
| Date of the denial remittance | Age of the denial under appeal | Denial management and appeal deadlines |
In practice, keep two views: from the due date, to collect, and from the submission date, to compare health plans with different terms. Anything before submission (discharged accounts not yet billed) stays out of billed aging and is measured separately, as the guide on DNFB (discharged not final billed) explains.
The aging template has one row per invoice and 14 columns
The aging template starts from one row per invoice (or per claim, when the health plan pays claim by claim), never one row per health plan. The table shows the template structure:
| Column | Content | Source |
|---|---|---|
| Health plan | Name and ANS registration | Contract record |
| Contract or product | When the health plan has different terms by product | Contract record |
| Invoice and batch number | Billing identification | Billing system |
| Protocol and submission date | Proof the batch was received | Health plan's TISS response |
| Discharge or service date | Date of care | Medical record or hospital system |
| Contractual due date | Submission date + contract term | Contract payment calendar |
| Billed amount | Amount submitted | Invoice |
| Paid amount | Sum of reconciled payments | Bank reconciliation and remittance |
| Denial under appeal | Contested denial awaiting response | Appeals log |
| Accepted denial | Denial the hospital chose not to contest | Denial log |
| Open balance | Billed − paid − accepted denial | Formula |
| Status | No response · Partially paid · Denial under appeal | Formula or picklist |
| Days outstanding | Report date − due date (negative = current) | Formula |
| Bucket | Current · 1–30 · 31–60 · 61–90 · 91–180 · Over 180 | Formula from days |
The report date sits in a single cell used by every formula. Accepted denial leaves the open balance and goes to write-off: keeping it in aging makes the portfolio look worse and hides the final loss. The guide Hospital accounts receivable covers allowances and write-offs.
With the data in place, the reading view is a pivot table: health plans in rows, buckets in columns, amounts and percentages of the total. HFMA specifies that each payer's buckets add up to 100% of its billed balance [8]. Percentages make it possible to compare health plans of different sizes.
Why these buckets. Up to 90 days, the buckets follow the 30-day model that HFMA also uses, and 90 days is Anahp's cutoff for bad debt [1][8]. The 91–180 bucket separates long delays from old balances; HFMA uses 91–120 and “over 120” [8]. A hospital can adjust the cutoffs to its contract calendars, as long as it keeps them stable over time.
How do you read the aging buckets?
Each aging bucket calls for a different action, and the balance status matters as much as its age.
| Bucket (from due date) | Typical reading | Action |
|---|---|---|
| Current | Within terms | Check that every batch has a protocol number and whether the remittance has been issued |
| 1–30 days | Recent delay, often operational | Confirm batch receipt, request the remittance by protocol number and check reconciliation [7] |
| 31–60 days | Repeated delay or claim not yet analyzed | Formal contact with the health plan's provider relations team, with the list of invoices and protocols |
| 61–90 days | About to become bad debt | Written notice citing the contract's payment clause; escalate to management |
| 91–180 days | Bad debt under Anahp's definition [1] | Balance reconciliation meeting, notice and the escalation path set in the contract |
| Over 180 days | Old balance, uncertain recovery | Executive decision: negotiation, formal measures or allowance |
Three readings complete the analysis:
- No response. A past-due invoice with nothing paid or denied points to a batch that was not processed. The first step is to request the remittance by protocol number, before chasing payment [4][7].
- Denial under appeal. It needs its own aging, counted from the remittance date, tracked against the response term in the contract. RN 503/2022 requires the contract to set terms for contesting, responding and paying after a reversal [6]. See the guide Denial management.
- Concentration. A small health plan with a large balance over 90 days weighs more in risk than the overall percentage suggests.
Collection priority comes from crossing amount, bucket and status
Age alone does not set priority: a large 45-day balance can deserve more attention than a small 200-day one. A practical order:
- Large balances in the 31–90-day buckets, which will soon become bad debt.
- Invoices with no response in any past-due bucket, which call for resubmission or a remittance request.
- Denials under appeal past their response term, pursued by citing the contract clause.
- Balances over 90 days by health plan, handled in a reconciliation meeting rather than invoice by invoice.
Collections follow the path set in the contract. The guide Health plan payment delays describes the hospital's rights and the possible escalation.
How much of Anahp hospitals' A/R is over 90 days?
In 2024, invoices over 90 days equaled 61.53% of an average month of billings at Anahp hospitals [1]. It is the closest public benchmark to aging in Brazil, Anahp's bad debt indicator: invoices open for more than 90 days divided by average monthly billings over the last 12 months [1].
| Indicator (Anahp hospitals) | Value | Period | Source |
|---|---|---|---|
| Bad debt (invoices > 90 days ÷ average monthly billings over 12 months) | 61.53% | 2024 | [1] |
| Collection rate (collected ÷ billed to health plans, last 5 years) | 88.61% | 2024 | [1] |
| Days in A/R (from invoice to payment) | 77.35 days | 2025 | [2] |
| Days in A/R | 73.84 days | Q1 2026 | [3] |
| Days payable to suppliers | 48.30 days | 2025 | [2] |
Put another way, the balance over 90 days equaled about 0.6 months of billings at the 119 hospitals that reported data to the Observatório [1]. To compare, a hospital computes the same ratio from its own aging: the sum of buckets over 90 days divided by average monthly billings over the last 12 months.
These are averages for member hospitals, a trend benchmark rather than a target. The guide Days in A/R for hospitals details the calculation and the historical series.
The most common aging mistakes
- Aging from the invoice date for every health plan, ignoring different contract terms.
- Leaving accepted denial in the balance, which inflates the older buckets.
- Not reconciling partial payments, which keeps invoices open at full value (see the guide Payer payment reconciliation).
- Changing bucket cutoffs from one month to the next.
- Not tying out to the general ledger: the aging total must match the health plan receivables balance on the report date.
- Treating aging only as a collection report. The balance in the older buckets is idle cash the hospital has to finance; the guide Hospital working capital shows how the collection period weighs on that financing.
What we see in operations
At Accrua, the aging report is built from reconciliation, invoice by invoice. Agents reconcile each remittance statement with the claim sent and classify the open balance by status: not yet due, no response from the health plan, denial under appeal or accepted denial. Only then do the age buckets come in, because each status calls for a different action.
For invoices with no remittance statement, status tracking flags when to request a response or resubmit. For denials under appeal, the response deadline in the contract is tracked, and the appeal goes out with the evidence the health plan asks for. Accepting a denial and writing off the balance is a person's decision, logged in an audit trail.
When the balance in the oldest buckets weighs on cash, Receita Garantida can put the value of eligible production into the hospital's cash on the schedule it needs. The risk read by health plan, plan and claim type, using historical payment time, denial rate and accepted appeals, is the same one that sets collection priority.
Where to start
- Set the report date (month-end) and the start date for each view: due date to collect, submission date to compare.
- Record each contract's payment term, to compute every invoice's due date.
- Build the data with one row per invoice, separating paid amounts, denial under appeal and accepted denial.
- Produce the health plan × bucket table, in amounts and percentages, and tie the total to the general ledger.
- Take the list over 60 days to the monthly meeting with each health plan, with invoices and protocol numbers.