Benchmark Methodology and Sources

BillingBench benchmarks are derived from primary institutional sources with publication dates and methodology notes on each figure. Primary sources include MGMA Physician Practice benchmark reports (annual), HFMA MAP Key performance metrics, CMS administrative data and cost reports, AHA Annual Survey data, AMA Physician Practice Benchmark Survey, and peer-reviewed revenue cycle literature from journals including Journal of Healthcare Finance and Healthcare Financial Management.

Each benchmark entry identifies: the specific source publication and year, the population of practices the figure applies to (by size, specialty, or region where available), the metric definition used by the source, and any known limitations or methodology caveats. Where multiple sources report the same metric with different figures, BillingBench reports the range and identifies the source for each bound.

The Denial Risk Scoring model: inputs are each normalized to a 0–100 score against the MGMA/HFMA benchmark range for that metric (0 = worst reported, 100 = top-decile performance). The six metric scores are weighted by their estimated contribution to total revenue leakage — denial rate (30%), days in AR (25%), net collection rate (25%), clean claim rate (10%), appeal overturn rate (5%), cost to collect (5%) — and averaged to produce the composite score. Specialty adjustments are applied to the benchmark targets for behavioral health, radiology, emergency medicine, oncology, and orthopedics.

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• Denial Risk Tool
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