Revenue Cycle

Medical Billing Benchmarks: The 2025 KPIs to Track

Clean claim rate, denial rate, days in A/R and net collections — the numbers that show whether your revenue cycle is healthy, and how to improve them.

Schedule a DemoView Plans and Pricing

Medical billing benchmarks are the industry targets a practice measures its revenue cycle against — how clean its claims are, how often payers deny them, how fast it gets paid, and how much of what it’s owed it actually collects. Tracking them turns billing from a black box into something you can manage and improve.

Below are the current benchmarks from MGMA, HFMA and industry claims data, what “healthy” looks like for each, and practical ways to close the gap — plus how the right EHR surfaces these numbers automatically. See how MedTec handles billing and reporting, or book a demo.

What are good medical billing benchmarks?

As a rule of thumb: a clean claim rate of 95%+ (98%+ is excellent), an initial denial rate under 5% (best-in-class under 3%), days in accounts receivable under 30–40, and a net collection rate of 96% or higher. Falling short on any one of these is usually where revenue leaks — and most of it is recoverable.

The Denial Problem

Why Billing Benchmarks Matter in 2025

Denials are rising — and reworking them is expensive.

11.8%
Average initial claim denial rate in 2024 — up steadily and trending toward 12–15% in 2025.
Experian State of Claims 2025
$25–$181
Cost to rework a single denied claim, depending on payer and complexity.
Industry (MGMA / AHA)
~70%
Share of denied claims ultimately overturned when appealed — most denials are recoverable revenue.
Experian State of Claims
The Benchmarks

Revenue Cycle KPIs & Healthy Targets

The five metrics that show whether your billing is healthy.

Metric (KPI)
Healthy benchmark
Warning sign
Clean claim rate
95%+ (98%+ excellent)
Below 90%
Initial denial rate
Under 5% (under 3% best-in-class)
Above 10%
Days in accounts receivable (A/R)
Under 30 days (31–40 acceptable)
Over 50 days
Net collection rate
96%+ (98–100% for large groups)
Below 94%
Patient collection rate
Collect more at point of service
Market average has fallen to ~34–48%

Sources: MGMA DataDive, HFMA, Experian State of Claims 2025, AAFP, CAQH. Benchmarks vary by specialty, payer mix and practice size.

How To Improve

How to Hit These Benchmarks

  1. Verify eligibility and authorizations up front. Missing or inaccurate data is the #1 denial cause, so catch it before the claim goes out.
  2. Scrub claims before submission. Automated edits and coding prompts push your clean claim rate toward 98%+.
  3. Track and categorize every denial. You can’t fix what you don’t measure — group denials by reason and payer to find the pattern.
  4. Work denials quickly. About 70% are overturned on appeal, but timely-filing limits mean speed matters.
  5. Monitor days in A/R every week. A rising A/R is an early warning of a cash-flow problem; catch it before it compounds.
  6. Collect from patients at the point of service. Patient collection rates are falling, so capture balances and card-on-file at check-in and checkout.
Related

Tools & Further Reading

Medical Billing

Charges auto-link from the encounter with coding prompts and validation, so billing starts from clean data.

Explore Medical Billing →

Reporting & Analytics

Dashboards surface denial rates, days in A/R and collections automatically — no spreadsheets.

Explore Reporting & Analytics →

The 3 Numbers to Check Monthly

Net collection rate, days in A/R and no-show rate — the KPIs to review every month-end.

Read the article →

Checkout & Patient Collections

How a smoother, FHIR-enabled checkout improves collections and patient loyalty.

Read the article →
Got Questions?

Frequently Asked Questions

What are good medical billing benchmarks?
Key targets are a clean claim rate of 95%+ (98%+ excellent), an initial denial rate under 5% (best-in-class under 3%), days in A/R under 30-40, and a net collection rate of 96% or higher.
What is a good clean claim rate?
95% or higher is considered good and 98%+ is excellent. A clean claim rate below 90% usually points to coding or data-entry problems that need fixing at the front end.
What is a good claim denial rate?
Providers should aim for an initial denial rate under 5%, with under 3% considered best-in-class. Industry averages have climbed to roughly 11.8% and are trending higher, so most practices have room to improve.
What is a healthy days in A/R?
High-performing practices keep days in accounts receivable under 30, with 31-40 days generally acceptable. Over 50 days signals a cash-flow problem worth investigating.
How can an EHR improve billing performance?
An EHR with integrated billing scrubs claims before submission, surfaces denial and A/R dashboards automatically, and links charges to clean clinical data – which raises clean claim rates and lowers denials.
Get Started
See Your Billing Numbers in Real Time

MedTec surfaces clean-claim, denial and A/R metrics automatically. Book a demo — or compare plans and pricing.

Schedule a DemoView Plans and Pricing