What is a good first-pass acceptance rate for medical billing?

A first-pass acceptance rate above 95% is the MGMA benchmark. Qualigenix achieves 95% across client practices through upfront eligibility verification and pre-submission claim scrubbing. Anything below 90% signals a systematic coding or eligibility problem that needs root cause analysis, not just resubmission.

What should days in AR be for a medical practice?

Most benchmarks place the target at 30 to 40 days. MGMA data shows the median for physician practices is around 35 days. Practices running above 50 days are losing cash flow and should audit their billing workflows, submission lag, and follow-up cadences by payer.

What is the average medical billing denial rate?

The national average sits between 5% and 10%. Best-performing practices stay below 5%. A rate above 10% points to eligibility verification failures, coding errors, or missing authorization documentation and should trigger an immediate root cause review.

What is net collection rate and why does it matter?

Net collection rate measures the percentage of collectible revenue your practice actually collects after contractual adjustments. A rate below 95% means money you were entitled to receive didn’t come in. Timely filing lapses and unworked patient balances are the most common causes.

How often should practice managers review billing KPIs?

Days in AR and denial rate should be reviewed weekly. First-pass rate and net collection rate should be reviewed monthly. Reviewing too infrequently means problems compound for weeks before anyone catches them. Build the review into a fixed meeting, not an ad hoc pull.

What causes high days in AR?

High days in AR usually traces back to slow claim submission, poor denial follow-up, inadequate payer contract management, or patient balance collections that aren’t happening at point of service. Break the number down by payer and provider to identify which bucket is the primary driver.

Should practices track AR over 90 days separately?

Yes. AR over 90 days is one of the most useful sub-metrics in revenue cycle management. MGMA recommends keeping it below 15% of total AR. Balances that age past 120 days become significantly harder to collect and often require write-off decisions that wouldn’t be necessary with earlier intervention.

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