RCM Benchmarks for Independent Practices

BillingBench publishes revenue cycle benchmarks drawn from MGMA Physician Practice benchmark reports, HFMA performance data, CMS administrative statistics, and peer-reviewed literature. Each benchmark includes the primary source citation, publication year, and methodology notes explaining how the figure was derived and which practice types it applies to.

Initial denial rate: the industry average across specialties is 5–10% of submitted claims (MGMA 2024 Physician Practice Benchmark Report). High-performing practices achieve denial rates below 5%. Specialties with higher denial rates include behavioral health (12–18%), radiology (10–15%), and emergency medicine (8–12%) due to prior authorization burden and documentation complexity.

First-pass clean claim rate: the target for high-performing practices is 95% or higher on first submission. Below 90% indicates systemic front-end issues — eligibility verification gaps, missing authorizations, or coding errors. First-pass rate directly drives days in AR; every percentage point improvement typically reduces AR days by 1.5–2 days.

Days in accounts receivable: the MGMA benchmark target is below 35 days for most specialties. Primary care practices typically achieve 25–30 days. Surgical specialties with high prior authorization burden (orthopedics, neurosurgery, oncology) run 40–50 days without active AR management. Days in AR above 50 indicates a collection risk requiring immediate intervention.

Net collection rate: the target is 95–97% of adjusted net charges (MGMA, HFMA). Below 90% indicates write-off volume that exceeds industry norms and signals either payer underpayment, timely filing losses, or inadequate denial follow-up. Appeal overturn rate for soft denials (medical necessity, prior auth, coding): 40–60% when appealed with appropriate documentation. Cost to collect: target below 3% of net revenue (MGMA staffing benchmarks).