Specialty-Specific Billing Benchmark Tool

A net collection rate (NCR) of 95% or above is the best-practice benchmark for most specialties according to MGMA DataDive. Top-quartile practices achieve 96-97%+. The national average across all specialties is 86-90%. NCR benchmarks vary by specialty — dermatology and ophthalmology typically achieve 95-97%; behavioral health and SUD practices have lower achievable benchmarks (75-88%) due to payer mix and population factors. Benchmarks should be adjusted for practice size and payer mix before comparing. See our Revenue Cycle Management services for NCR improvement strategies.

Best-practice denial rates vary significantly by specialty. Primary care and dermatology target below 7%; cardiology and orthopedics target below 9%; behavioral health averages 16-23%; and oncology/hematology can reach 13-19% due to prior authorization and medical necessity complexity. The national average across all specialties is approximately 11-13%. Any denial rate above your specialty benchmark represents recoverable revenue through pre-submission coding accuracy and prior authorization management.

Days in AR benchmarks range from 26-35 days for procedural specialties with clean billing (dermatology, ophthalmology) to 45-65 days for complex specialties with high prior authorization requirements (oncology, pain management). Primary care target is 35-42 days. Any specialty exceeding 55+ days in AR typically has systematic AR management issues — unworked denials, slow secondary billing, or inadequate patient follow-up — that are addressable through structured AR triage. See our Denial Management services.

Practice size has measurable impact on billing performance: solo practices typically achieve NCR 1.5% lower, denial rates 2.5% higher, and AR days 5+ days longer than mid-size group practices. Enterprise groups (50+) achieve NCR 1% higher, denial rates 1% lower, and AR 4 days shorter. Payer mix is equally significant: Medicaid-heavy practices (over 50%) have NCR benchmarks 2% lower, denial rates 3% higher, and patient collection rates 8% lower than mixed-payer practices. Commercial-heavy practices see the reverse — NCR 1% higher, denial rates 1% lower, AR 3 days shorter. This tool adjusts benchmarks for both factors simultaneously.