Made every claim an owned record
44,228 claims
- Worked means a dated action with an outcome; 189,743 touches, none unowned
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Case study · Rural district hospital
Claims submitted rose 94%. Accounts receivable did not move.
Short answer: a rural district hospital went from $18.69 million to $30.69 million of claims a month, with a record $43.49 million in June 2026. Insurance AR moved from $47.11 million to $48.98 million and days in AR held at 43. Growth was absorbed by working the book, not by letting it age.
44,228 claims · 100% touchedMedian claim to remit 20 daysBill lag 11 to 8 daysUntouched over 60 days $490K
Edition
Oct 2026
Archetype
Rural district hospital
Horizon
Aug 2025 to Aug 2026
Metric
43 days in AR
Payers
About 80% government
Length
6 min read
+94%claims
Submitted per month, $18.69M in 2025 to $30.69M on the trailing three months to August 2026
43days in AR
On gross charges, with insurance AR at $48.98M against $47.11M
4.3touches per claim
Documented touches across a 44,228-claim book, 100% worked
$490Kuntouched
AR over 60 days on a $49M book; $12K over 90 days on the payer clock
From takeover to the board review
Its cash story has its own page; this one is about the receivable while claim volume doubled.
- 1Aug 2025ASP takes over the full revenue cycle; about 80% government payers
- 22025Claims submitted $18.69M a month
- 3Jun 2026Record month: $43.49M submitted
- 4Jun to Aug 2026Trailing three months $30.69M a month, up 94%
- 5Aug 2026Insurance AR $48.98M against $47.11M; days in AR 43
- 6Aug to Sep 2026Follow-up coverage and two-clock aging reviewed with the board
Submissions
+94% year on year
Insurance AR
+4%: $47.11M to $48.98M
Days in AR
43, under the 50-day benchmark
VolumeReceivableDays
AR within 4 percent, 43 days
Claims submitted per month versus insurance AR
ASP-RCM engagement records$18.69MbaselineSubmitted per month2025
$30.69M+94%Submitted per monthtrailing 3 months to Aug 2026
$43.49MrecordSubmittedJune 2026
$47.11MInsurance ARbefore
$48.98M+4%Insurance ARAug 2026
BaselineSubmissionsReceivable held
Takeaway
Nearly twice the claims, AR up 4 percent, 43 days in AR. Growth was absorbed by working the book, not by letting it age.
Follow-up coverage, August to September 2026
| Measure | Value | What it means |
|---|---|---|
| Claims in the managed book | 44,228 | the whole worked receivable |
| Claims with a documented touch | 100% | no claim unowned |
| Documented touches | 189,743 (4.3 per claim) | a dated action with an outcome |
| Untouched AR over 60 days | $490K on $49M | reported against ourselves |
| Untouched AR over 90 days, payer clock | $12K | from first-bill date |
Electronic remittance cash by days from claim to remit, 2026
Dollar-weighted. Payment velocity sets each claim's follow-up date.
Within 30 daysshare of ERA cash
68%
Within 60 daysshare of ERA cash
83%
Median, all payersdollar-weighted
20 days
Median, largest payer
14 days
Median, Medicaid managed care plan
9 days
020406080
Share of cash, percentMedian, all payers, daysMedian by payer, days
Operating scorecard, July 2026 against 2025
Cash receipts per business day
$100KBefore2025
$157KAfter2026
Bill lag, median days from service to claim
11 daysBefore2025
8 daysAfter2026
Charge lag, days
20.5Before2025
11.2After2026
Late-billed claims, over 30 days
On watch
8%Before2025
7%After2026
Takeaway
Bill lag and charge lag are what let a hospital double its submissions without doubling its AR: a claim that leaves in 8 days instead of 11 is paid in the month it was billed.
The same receivable by date of service and by first-bill date
| Bucket | By date of service | By first-bill date | Reading |
|---|---|---|---|
| 31 to 60 days | $13.04M | $5.48M of it billed within the last 30 days | 58% of the book re-billed within 30 days |
| Over 90 days | 19% | 14.7% | service date says how old the care is; first-bill date says how long the payer has had it |
Date of service clock
Finance view
How old the care is: the CFO's list
First-bill date clock
Follow-up queue
How long the payer has had the claim: the AR team's list
Publish both
Monthly
Two different lists, both reported
Six moves
Reported untouched AR against ourselves
$490K
- Over 60 days untouched is the figure the board sees each month; it should go to zero
Cut bill lag before adding people
11 to 8 days
- Charge lag 20.5 to 11.2: why doubled submissions did not become doubled AR
Measured payment velocity by payer
20-day median
- 14 for the largest payer, 9 for the Medicaid plan; sets each claim's follow-up date
Aged the book on two clocks
Both published
- Date of service for finance, first-bill date for the follow-up queue
Kept late-billed claims on watch
7%
- Beats 8% and is not yet where it should be
Reported when measured, not before
- 7.8Discharged-not-final-billed ran 7.8 days against a target under 5At the August 3 snapshot: a breach of the proposed scorecard, and the front-end measure being worked hardest.
- 1.3%Preventable timely-filing loss was $165,581 across 76 claims1.3% of the $13.2 million receivable reviewed; small, real, ours to prevent.
- $490KOver 60 days is still untouchedAbout 1% of a $49 million book; it should be zero.
- 7%Late-billed claims are on watchBill lag improved; the over-30-day tail has not closed.
- NCRNet collection rate is pending the non-ERA feedPublished when the feed is complete.
Frequently asked questions
How did submissions nearly double without AR rising?
Bill lag fell from a median of 11 days to 8 and charge lag from 20.5 to 11.2, so claims left sooner; the median claim paid in 20 days with 68 percent of remittance cash inside 30; and every one of 44,228 claims had a documented touch, 4.3 on average. AR moved from $47.11 million to $48.98 million while monthly submissions went from $18.69 million to $30.69 million.
What counts as a touch?
A dated action logged against the claim with an outcome: a status check, a call, a corrected claim, an appeal. Opening a claim is not a touch. 189,743 touches were recorded across 44,228 claims, and untouched AR over 60 days was $490K, the figure we report against ourselves.
Why age the receivable on two clocks?
Date of service shows how old the care is; first-bill date shows how long the payer has had the claim. The 31-to-60 day bucket was $13.04 million by date of service but $5.48 million of it had been billed in the last 30 days, and the over-90 share read 19 percent on one clock and 14.7 percent on the other.
What is still not where it should be?
Discharged-not-final-billed ran 7.8 days against a target under 5 at the August 3 snapshot, late-billed claims are 7 percent, $490K over 60 days is untouched, preventable timely-filing loss was $165,581 across 76 claims, and net collection rate waits on the non-ERA feed.
- eCFR 42 CFR 424.44: Time limits for filing claims (one calendar year after the date of service)
- eCFR 42 CFR 412.2: Basis of payment (Medicare pays a predetermined amount per discharge)
Dollar-weighted. Payment velocity sets each claim's follow-up date.
Find your untouched dollars
We measure touches per claim, untouched AR over 60 days, payment velocity by payer and your receivable on both clocks, before anyone decides you need more people.