Why Is My Office Ally AR Report Full of Credits Over 90 Days?
Short answer: Run your AR report and treat the over ninety days column as a symptom, not a diagnosis. Open the visits behind that balance and look for credits. Credits on aged visits mean Apply Autopost was clicked more than once, so the same payment applied two or three times, and patient responsibility was never selected, so the balance never reached a billing statement. Post the payment as paid by the insurance, adjust off the contracted amount, note the reason in the reference field, then select patient responsibility and confirm the two check marks appear.
https://www.youtube.com/watch?v=wI4cZMeIGPM
What the AR report is actually telling you
A large unexplained balance sitting over ninety days looks like a collections problem. Money is owed, nobody is paying, and the obvious next move is to start chasing patients. Open the visits first. If those visits are carrying credits, this is not a collections problem at all. It is a posting problem, and the two look nothing alike once you know what you are seeing.
Autopost does part of the work and cannot do the rest. It will not close a visit and it will not mark patient responsibility. In the account behind this lesson the visits were closed, and closing a visit can only be done by hand, so somebody was already in there working manually. If the visit status had to be changed by hand anyway, the payment could have been posted by hand correctly in the same pass.
The steps
Run your AR report.
Look at the over ninety days column. A large unexplained balance there is the symptom, not the problem.
Open the visits behind it.
Look for credits sitting on the visits. Credits on aged visits point at posting, not at patients.
Understand the cause. Apply Autopost was clicked more than once, possibly two or three times, and each click applied the same payment again.
Check the visit status. The visits were also closed, and autopost cannot close a visit. Changing the visit status is manual, always.
To post it correctly, record the payment as paid by the insurance.
Adjust off the contracted amount.
Make a comment in the reference field, for example deductible or co insurance is due.
Select patient responsibility.
Watch for the two check marks that are added when you do.
Confirm billing statements are actually going out every month.
Why those two check marks decide whether you ever get paid
The two check marks that appear when you select patient responsibility are what put the balance on a billing statement. If they are not checked, the balance does not show up on a billing statement at all. That is the mechanism behind an aging balance nobody is collecting. It was never billed, because it was never marked. A correctly marked balance still needs a statement to reach the patient, so the monthly statement run matters just as much. In this case the previous biller was not sending billing statements every month either, which compounds the whole problem.
The mistake this prevents
Clicking Apply Autopost more than once. Autopost does not confirm what is already applied. A second or third click applies the same payment again, and the account absorbs it quietly as a credit on the visit. The ledger stops describing reality, the AR report reflects the distortion, and the practice cannot tell money genuinely owed from money that was posted twice. The damage compounds across months, so by the time anyone asks questions, unwinding it means going visit by visit. Click once. If you are unsure whether it applied, check before you click again.
The second mistake is trusting autopost to finish a job it cannot finish. It will not close a visit and it will not mark patient responsibility, so the two check marks that put a balance on a statement never get set unless a person sets them. Those balances fall through the gap, age into the over ninety column, and look like patients who will not pay. Post the payment, adjust the contracted amount, note the reason in the reference field, select patient responsibility, and confirm the check marks appeared, in that order, before moving on.
More Office Ally training
Watch the walkthrough: Office Ally User Tips playlist
Watch this one: Why Your Over 90 Days Is Lying To You https://www.youtube.com/watch?v=wI4cZMeIGPM
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Medical Receptionist and Biller Course: mariematteson.com/medcourse
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Marie Matteson, MS, is a healthcare consultant, educator, and Office Ally specialist with more than 30 years in healthcare, emergency medicine, and practice management. Helping you understand what's really going on.
All patient information referenced here has been redacted. This content is educational and is not billing, legal, or coding advice. Always follow your payer contracts, your practice policies, and current coding guidelines. Not affiliated with or endorsed by Office Ally.
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