Revenue Cycle Benchmarks by Medical Specialty

Specialty-specific revenue cycle benchmarks drawn from MGMA Physician Practice benchmark reports, HFMA performance data, and CMS specialty-level administrative statistics. Denial rates, days in accounts receivable, net collection rates, and cost-to-collect figures vary significantly by specialty due to differences in payer mix, prior authorization burden, documentation complexity, and claim volume.

Primary care: denial rate 4–7%, days in AR 25–32, net collection rate 96–98%. Cardiology: denial rate 6–10%, days in AR 32–42, prior authorization required for stress testing, echocardiography, and cardiac catheterization across most commercial payers. Orthopedic surgery: denial rate 8–13%, days in AR 38–52, high prior auth burden for joint replacement, spine surgery, and arthroscopy. Oncology: denial rate 10–15%, days in AR 40–55, frequent medical necessity and drug coverage denials.

Behavioral health and psychiatry: denial rate 12–18% — the highest of any specialty — driven by medical necessity criteria variability, parity compliance failures, and lack of standardized coding benchmarks. Emergency medicine: denial rate 8–12%, driven by out-of-network billing complexity and high volume of uninsured patients. Radiology: denial rate 9–14%, driven by prior authorization for advanced imaging (MRI, CT, PET). Dermatology: denial rate 5–9%. Gastroenterology: denial rate 7–11%, high prior auth for advanced endoscopy. Neurology: denial rate 8–13%.

Obstetrics and gynecology: denial rate 5–9%, with elevated coordination-of-benefits denial rates for maternity episodes. Physical therapy: denial rate 10–15%, high frequency of medical necessity denials and visit-limit denials from Medicare Advantage and commercial plans. Urology: denial rate 7–11%.