Hospitals and health systems rely on stable cash flow to maintain daily operations. However, when unpaid bills accumulate, money becomes tied up in accounts that are slow to collect.
Most healthcare organizations aim to keep less than 15–20% of their accounts receivable (A/R) past 90 days; however, once balances creep above that range, financial strain grows quickly. This is where aged A/R, or accounts receivable that are more than 90 days old, becomes a real challenge.
The larger the health system, the more challenging it is to track these balances across multiple facilities.
One way organizations are addressing this issue is by leveraging specialized assistance from EBO teams. These teams focus on patient balances, insurance follow-up, and process improvements that prevent accounts from aging.
They provide hospitals with a way to stay on top of revenue without placing additional stress on internal staff.
To understand their impact, it is helpful to start with the basics: what aged A/R means, what EBO teams do, and why multi-facility systems benefit significantly from their support.
What Does A/R Mean?
When a hospital provides care, payment is often made later. That money owed is referred to as accounts receivable. It includes what patients owe directly and what insurance companies are responsible for paying. This money is part of the hospital revenue cycle, which tracks every step from service to final payment.
Not all receivables are the same. They are grouped into “aging buckets” based on the length of time the payment has been pending. The most common groups are:
- 0–30 days: New balances, usually still moving through insurance or patient billing.
- 31–60 days: A little older, may need reminders or claim follow-up.
- 61–90 days: At risk of delay, needs attention to prevent write-offs.
- 90+ days (aged A/R): Most difficult to collect, often caused by insurance denials, patient delays, or missing documents.
Hospitals track aged accounts receivable (A/R) closely because the longer a balance waits, the less likely it is to be collected. Effective accounts receivable management involves preventing a high number of accounts from reaching the 90-day bucket.
There are many reasons for a balanced age. Sometimes insurance requests extra paperwork. Sometimes, patients need clear payment options, but they do not receive them on time. In some cases, payer behavior red flags—such as slow responses or frequent denials—cause a large number of claims to remain unpaid.
Without proper focus, aged accounts receivable (A/R) builds up across a healthcare system. It reduces cash flow, delays investments, and can even limit staffing or new equipment purchases. That is why hospitals use tools, teams, and sometimes outsourced billing services to manage these balances more effectively.
What Are EBO Teams?
An EBO, or extended business office, works as an extra support team for hospitals. Instead of replacing the central billing office, they act as an extension of it. Their primary role is to assist with billing and collections tasks that the in-house staff may not have time to manage.
EBO teams are trained in healthcare-specific processes. They understand how to:
- Contact patients in a professional and friendly way.
- Work with insurance companies on outstanding claims.
- Set up payment plans that make bills easier to manage.
- Identify problems with denied claims and correct them quickly.
- Clear old balances left behind after a system upgrade or facility merger.
Hospitals often turn to EBO support because internal staff are stretched thin. Many systems are dealing with higher patient volumes, more complex payer rules, and staffing shortages. Adding EBO support ensures that no account is left behind.
Some organizations use EBO teams as a form of debt collection outsourcing. But unlike aggressive collections, these teams focus on patient engagement and compliance. They also protect patient relationships by using clear communication and offering options before accounts are referred to outside collectors.
The strength of EBO teams is their flexibility. They can scale up or down depending on the workload. For example:
- During busy seasons or after an electronic health record change, they handle overflow.
- For legacy systems, they help close out old accounts that would otherwise stay on the books.
- For denials, they can focus on appeals while in-house staff manage new claims.
By supporting these areas, EBO teams improve healthcare accounts receivable results. They help lower days in accounts receivable (A/R), reduce write-offs, and bring more cash back to the hospital more quickly. This teamwork enables hospitals to focus on patient care while maintaining a stable financial health.
Why Multi-Facility Health Systems Need Extra Help
Running one hospital is already complex. Running a health system with many hospitals and clinics multiplies the challenges. Each facility may have different processes, billing systems, or payer contracts. Without strong coordination, aged accounts receivable (A/R) can grow quickly.
Multi-facility systems face unique barriers:
- Multiple billing platforms: Some facilities may still use outdated systems, making it more challenging to track balances in one place.
- Different payer contracts: Rules vary across states and insurance plans, resulting in delays.
- Staffing shortages: Each hospital may not have enough trained staff to cover every account.
- High patient volume: More visits create more claims, and even a small error rate leads to thousands of unpaid balances.
This is where EBO teams become especially valuable. They implement a single standard process across all facilities. They bring structure and consistency to billing and collections for every location, regardless of size. This helps the health system collect more money while reducing confusion for patients.
For large systems, EBOs often manage legacy accounts receivable (A/R) during mergers. When a new hospital joins, the old system still has unpaid balances. An EBO can close those accounts, allowing the main staff to focus on current operations.
EBO teams also bring advanced reporting. They can identify payer behavior red flags across multiple facilities, such as one insurer consistently delaying claims. This system-wide view allows leadership to address problems quickly.
Without this kind of support, multi-facility health systems often struggle to meet goals for accounts receivable management. Balances age faster, cash flow weakens, and staff burnout increases. EBO support mitigates these risks and provides leadership with confidence that the system’s finances are being managed effectively.
By combining local care delivery with centralized financial support, healthcare systems can grow without being hindered by unpaid balances. That balance between care and collections is what makes EBO teams such an essential part of modern healthcare operations.
How EBO Teams Help Reduce Aged A/R for Multi-Facility Health Systems
When hospitals and health systems talk about money owed, they usually mean aged accounts receivable, or aged A/R. These are unpaid balances that sit for months, often 90 days or more. The longer they stay unpaid, the harder it is to collect. For multi-facility health systems, aged A/R is an even bigger challenge because the numbers come from many hospitals, clinics, and outpatient centers all working together.
This is where EBO teams, also called extended business office teams, make a difference. They step in as trained partners who know how to manage accounts and work with both patients and insurance companies. Their goal is to reduce aged A/R, improve collections, and keep the system’s cash flow steady.
Below is how they help in practical, detailed ways.
1. Early and Consistent Patient Contact
EBO teams make sure patients hear about their bills early. Instead of waiting until an account is overdue, they reach out soon after the first statement is sent. This step matters because many patients simply forget or do not understand their bills.
EBO staff explain balances in plain language and give payment options. They can:
- Offer online portals or phone payment choices.
- Help patients set up monthly payment plans.
- Guide patients through financial assistance if they qualify.
Clear communication lowers stress for patients and helps the hospital collect sooner. This prevents many accounts from ever reaching the 90-day aged bucket. It also protects the hospital revenue cycle, since cash moves more smoothly when bills are addressed early.
2. Insurance Follow-Up and Denial Management
Many aged balances are linked to insurance claims, not patients. Claims can sit unpaid because of small errors, missing paperwork, or denials. EBO teams are trained to work with insurance companies and resolve these issues quickly.
Their work includes:
- Reviewing claims flagged by insurers.
- Submitting missing documents or corrections.
- Tracking appeal deadlines and making sure no claims expire.
- Identifying common denial reasons and reporting them to the health system.
This process is a core part of accounts receivable management. By focusing on insurance-related delays, EBO teams prevent balances from aging past 90 days. They also reduce write-offs and give leaders clearer information on payer trends.
3. Handling Overflow and Special Projects
Large health systems often face staffing shortages or sudden changes, such as switching to a new electronic health record. These moments create backlogs. Instead of allowing unpaid balances to grow, EBO teams step in to handle the overflow.
Examples include:
- Working on old accounts left behind after a hospital merger.
- Clearing small-dollar claims that still matter but often get ignored.
- Providing extra staff during busy flu or surgery seasons.
By managing these projects, EBO teams free up internal staff to focus on current claims and patient care. This balance keeps the whole system moving forward without drowning in old receivables.
4. System-Wide Consistency
Multi-facility systems often operate across states or regions. Each facility may have its own billing process, payer contracts, or patient volume. Without coordination, aged A/R builds unevenly across locations.
EBO teams bring one consistent structure to billing and collections across the entire system. They use the same scripts, reporting tools, and communication style. This makes the patient experience smoother. A patient visiting two hospitals in the same system should hear the same message about their bills, and EBO teams make that happen.
Leaders also benefit from standard reporting. They can see aged A/R levels across every facility in one dashboard. This makes it easier to make decisions and hold staff accountable.
5. Use of Outsourced Resources
For some hospitals, hiring and training new staff for every billing task is difficult. In these cases, EBO teams may operate as outsourced billing services. They give hospitals access to skilled professionals without adding new full-time employees.
Outsourcing helps systems:
- Scale staffing up or down as needed.
- Control costs without reducing quality.
- Gain expertise from teams who work with many health systems.
This form of support blends well with internal teams. Leaders keep control of policies and patient experience, while EBO staff handle day-to-day receivable tasks.
6. Compliance and Patient Care
EBO teams are trained to follow healthcare rules. This matters when bills are overdue. Hospitals must make “reasonable efforts” to contact patients before sending accounts to collections. EBO teams document every call, letter, and email so the system remains compliant.
Unlike harsh debt collection outsourcing, EBO staff use respectful communication. They act as an extension of the hospital’s brand, not as an outside agency focused only on money. By keeping conversations professional and friendly, they maintain patient trust.
7. Identifying Problem Patterns
Because EBO teams work across many accounts, they often see patterns faster than internal staff. For example:
- A certain insurer may delay payments by always asking for the same extra paperwork.
- A hospital may have repeated coding errors that lead to denials.
- Patients may frequently misunderstand statements from one facility.
These patterns are called payer behavior red flags when linked to insurers. By reporting them, EBO teams help hospitals fix problems at the source. This prevents new aged A/R from forming and makes the whole system more efficient.
8. Legacy and Dormant Accounts
One of the hardest parts of A/R management is dealing with old or inactive accounts. These are balances that have been sitting for years, often after a system upgrade or a merger. Internal staff rarely have the time to focus on them.
EBO teams take on these projects with clear goals. They help recover dormant debt by:
- Sorting through old balances and removing duplicates.
- Contacting patients with professional notices.
- Working with payers if claims are still valid.
- Closing out accounts that are no longer collectible.
Recovering even a portion of these balances can mean millions of dollars for a large system. It also clears the books and gives leadership a fresh starting point for new operations.
9. Measurable Results
Hospitals measure A/R performance using metrics like days in A/R, percent of A/R over 90 days, and denial overturn rates. EBO teams can show improvements in each of these areas.
Typical results include:
- Reduced A/R over 90 days.
- Faster collection of insurance balances.
- Lower write-offs due to missed deadlines.
- More consistent patient satisfaction with billing.
These outcomes show why many health systems continue using EBO teams long term. The improvements are measurable, and they support both financial health and patient care.
10. A Practical Extension of the Hospital
In the end, EBO teams are part of the system’s larger strategy. They do not replace staff. Instead, they give hospitals the ability to handle more accounts, collect faster, and keep aged A/R under control.
They also support compliance, patient trust, and operational efficiency. For multi-facility health systems, this kind of structured support is essential. Without it, receivables age quickly, and financial stability suffers. With it, leaders gain confidence that the healthcare accounts receivable process is under control.
By combining patient-friendly communication, insurance expertise, and data-driven reporting, EBO teams create real value. They help hospitals stay focused on care while still meeting financial goals. That balance is why their role in reducing aged A/R is so important today.
Conclusion
Managing aged A/R is a serious challenge for health systems, especially those with many facilities. By adding the support of EBO teams, hospitals can reduce old balances, speed up collections, and keep their finances strong.
The role of EBO teams in reducing aged A/R for multi-facility health systems is clear: they bring structure, consistency, and relief for busy staff while protecting patient relationships.
Want expert help with your system’s receivables? Reach out to Medical Data Systems today to learn how the right support can improve your financial health.
FAQs
What is aged A/R?
Aged A/R means accounts receivable that are 90 days or older and have not yet been paid by patients or insurance.
How do EBO teams differ from collection agencies?
EBO teams focus on patient-friendly communication, payment plans, and insurance follow-up before sending accounts to collections.
Why do multi-facility health systems struggle with A/R?
They face complex billing systems, payer differences, staffing shortages, and high patient volume, which make accounts harder to track and collect.
What benefits come from using outsourced billing services?
Hospitals gain extra staff support, faster cash flow, lower aged A/R, and more consistent processes across all facilities.
Can EBO teams help with payer denials?
Yes. EBO teams often handle appeals and track denial trends, helping hospitals prevent similar issues in the future.