What Is a Good Clean Claim Rate?
Ninety-five percent. That’s the floor. The reciprocal is a 5% denial rate — which sounds manageable until you see how many follow-up hours that 5% generates downstream. Most practices below 95% aren’t losing to payer behavior. They’re losing to their own intake process.
Three variables move this number more than anything else: payer grid accuracy, front desk eligibility verification, and system data quality. If your front desk isn’t running eligibility before the patient walks in the door — not at check-in, before they’re scheduled — you’re generating dirty claims before a coder touches the chart. That’s not a billing problem. That’s a scheduling problem that became a billing problem. We find this in roughly half the audits we run. Nobody at the front desk mentioned it.
Below 90%? Stop looking at the payers. Pull your denial breakdown by rejection code and trace every one back to intake. The payer is just returning what you already sent them wrong. → link to services page
What Does Good AR Look Like?
Per MGMA, less than 20-25% of your AR should be over 90 days. Dermatology running clean: closer to 10-15%. Anything above 25% and you’re not managing AR — you’re storing it.
Plastics is more nuanced. A practice doing two complex cases a month can look like it has 50% of AR over 90 days because one claim is sitting on medical records. That’s not a billing failure. That’s math. And math doesn’t warrant a call to your billing company at 8 AM on a Thursday.
When benchmarking plastics AR, adjust for volume. A low-volume practice with two stuck claims and a high-volume practice at the same percentage are in completely different situations. The percentage isn’t the KPI — the denominator is. → link to practice management page
Days Revenue Outstanding: Benchmarks by Practice Model
DRO measures collection speed. Best case: 20-25 days. That’s derm. That’s not most plastics practices, and it’s not OON anything.
OON-IDR: 3-6 months. Traditional OON: 6-18 months. In-network plastics: 25-60 days. Dermatology running clean: 20-25 days. Know all four before you benchmark. Most practices that come to us with a DRO question don’t actually know which model they’re running. That’s where the benchmarking exercise usually ends.
Benchmarking your OON plastics practice against derm in-network numbers isn’t benchmarking — it’s flattering yourself. Know your network status, know your specialty, then pull the number. → link to OON billing page
The Biggest Billing Mistake (It’s Not Coding)
AR follow-up is where billing departments go to die. It’s 60% of the billing day, the most transactions, and the highest decision complexity in the cycle. Most medbillcos are built coding-heavy and AR-light. That’s not a coincidence — coding is easier to staff, easier to train, and easier to report on. AR is where the judgment calls live.
You code once. You follow up ten times. One wrong NPI at intake generates a rework chain that compounds through your AR for months. By the time you’re chasing that claim at 90 days, the coder who touched it is long gone and the follow-up team owns a mess they didn’t make.
Build your AR team before your coding team. That’s where the money is. → link to RCM services
Pull These Four Numbers Now
Clean claim rate. AR over 90 days. DRO. AR follow-up time per claim. If your PM system can’t surface all four in under five minutes, that’s diagnostic. Not of the payers. Not of the coders. Of the infrastructure.
The Auctus Group runs billing audits that start with these four numbers and trace every outlier back to its source. → link to scope request form
