Revenue cycle management for medical practices.

What to track.

• Days in A/R — how long, on average, money is owed before it’s collected.
• A/R over 90 days — the slow bucket where collection probability drops fast.
• Denial rate — what percent of claims come back unpaid the first time.
• Denials by payer and denials by root cause — concentration tells you where to focus.
• Net collection rate — collections as a percent of what you could have collected.
• Clean claim rate, charge lag, payment lag, patient collection rate, underpayment rate.

Common problems.

• Claims are submitted late, costing the practice days before the payer even sees the claim.
• Denials are tracked but not solved by root cause, so the same errors repeat.
• Patient balances are addressed after the visit, when collection probability is lower.
• A/R follow-up is inconsistent and old claims sit in the system.
• Billing and finance are disconnected, so owners cannot see the cash impact of RCM performance.

Practical fix.

Build a weekly revenue cycle review covering: claims submitted, cash collected, A/R aging, denials by category, high-dollar claims at risk, patient balances, underpayment issues, and next actions by owner. The purpose is not to review every claim. The purpose is to identify revenue that’s stuck and assign action before it becomes a cash problem.

Benchmarks worth comparing against.

Numbers vary by specialty, payer mix, and practice size, but a healthy independent practice tends to see:

• Days in A/R — under 35 days for primary care; under 45 for surgical specialties.
• A/R over 90 days — below 15–18% of total A/R.
• First-pass clean claim rate — above 92%.
• Net collection rate — above 96% for contracted payers.
• Denial rate — under 8%, with the top three denial reasons solved each quarter.

If you don’t know your numbers, that’s the first finding. The exercise of pulling them often reveals which payer is the real source of friction.

Mistakes that cost the most money.

• Treating denials as one-offs. Each denial is a data point. Track the root cause code and the responsible step in the workflow. Most denials come from a small set of fixable causes.
• Not collecting at the front desk. Patient responsibility collected after the visit drops dramatically. Eligibility verification and time-of-service collection move the needle more than any back-office process improvement.
• Letting old A/R sit. After 120 days, the probability of collection falls below 30%. Write-off rules and a small claims policy beat infinite follow-up.
• No reporting cadence. If billing is reviewed monthly, four weeks of leakage compound before anyone sees it. A weekly cadence pays for itself within a quarter.

A short example.

A 7-provider specialty practice in the Southeast had days in A/R of 58 and an over-90 bucket at 27%. The owner thought they had a collections problem. The first 30 days of a structured RCM review found: 60% of denials traced to two CPT codes flagged for medical necessity by one payer; another 20% to eligibility errors at intake. Fixing intake and submitting corrected documentation on the two codes dropped denials by half within 90 days. Days in A/R moved from 58 to 39 in a quarter. Cash, not revenue, was the change worth noticing.

Questions practice owners ask.

Is in-house or outsourced billing better? Neither is universally better. What matters is whether someone owns the metrics, reviews denials weekly, and has authority to fix root causes. Outsourced billers without accountability produce the same results as understaffed in-house teams.

How quickly should this show in cash? Most RCM improvements show meaningful cash impact in 60–90 days. The work is unglamorous and continuous, not a one-time project.

Do we need new software? Usually no. Most practices already pay for tools they don’t use fully. New software is rarely the answer; new accountability and reporting almost always is.