Revenue Cycle Benchmarking

A Measurable Framework for RCM Performance

At VelanSync, our Revenue Cycle Management (RCM) framework is aligned with industry-recognized Medical Group Management Association (MGMA) benchmarking principles. We use these benchmarks to establish measurable performance expectations, identify revenue leakage, strengthen operational efficiency, and support sustainable financial performance for healthcare providers.

Our approach focuses on the complete revenue cycle from front-end patient access and eligibility verification through claims submission, payment posting, denial management, and A/R recovery.

Key RCM Performance Benchmarks

Performance Targets

VelanSync uses measurable objectives across the revenue cycle to monitor performance and identify opportunities for improvement.

01

Clean Claim Rate

≥98%

We target a clean claim rate of 98% or higher, helping minimize avoidable rejections, claim delays, and administrative rework.

Focus Areas

  • Accurate patient demographics
  • Insurance eligibility verification
  • Correct CPT/HCPCS and ICD-10 coding
  • Authorization validation
  • Payer-specific billing requirements
  • Complete claim documentation

02

Days in A/R

≤35 Days

We target 35 days or less in Accounts Receivable, with continuous monitoring of payer and patient A/R.

Our objective is to accelerate reimbursement while identifying aging accounts before they become difficult to recover.

03

A/R Aging — 90+ Days

<20%

We monitor the percentage of outstanding A/R that is more than 90 days old.

Target: Less than 20% of total A/R

A/R aging is reviewed by payer, provider, financial class, denial category, and aging bucket to identify trends and prioritize recovery.

04

A/R Aging — 120+ Days

<10%

Accounts exceeding 120 days require focused intervention.

Target: Less than 10% of total A/R

Our teams prioritize high-value and high-risk aging accounts through structured follow-up, appeals, documentation review, and escalation.

05

Net Collection Rate

≥95%

We target a 95% or higher Net Collection Rate, measuring the effectiveness of collecting collectible revenue after contractual adjustments and other applicable deductions.

This KPI helps identify

  • Missed reimbursement
  • Underpayments
  • Incorrect contractual adjustments
  • Unresolved denials
  • Patient balance leakage

06

Eligibility Verification

≥98%

We target 98% or higher eligibility verification accuracy before services are rendered.

Helps reduce

  • Coverage-related denials
  • Incorrect patient responsibility
  • Registration errors
  • Unnecessary claim rework
  • Delayed reimbursement

07

Initial Claim Denial Rate

≤5%

VelanSync establishes a target initial denial rate of 5% or lower, recognizing that actual performance varies by specialty, payer mix, claim complexity, and practice characteristics.

Denials are categorized by root cause and tracked through resolution to prevent recurring issues.

08

Denial Resolution

Within 30 Days

Our operational target is to address and resolve actionable denials within 30 days, wherever payer timelines and documentation requirements permit.

Denial management includes

  • Root-cause analysis
  • Corrected claims
  • Appeals
  • Documentation retrieval
  • Payer follow-up
  • Underpayment identification
  • Preventive action plans

09

Charge & Claim Submission Lag

24–48 Hours

We target charge capture and claim submission within 24–48 hours, subject to documentation availability and provider workflow.

Reducing submission lag helps improve cash flow and minimizes unnecessary delays in reimbursement.

Comprehensive RCM Monitoring

Monitor the Metrics That Drive Performance

In addition to the core benchmarks, VelanSync monitors a broad set of financial, operational, and revenue-cycle indicators to identify trends, exceptions, and opportunities for improvement.

Gross Collection Rate
First-Pass Claim Acceptance
Claim Rejection Rate
Denial Rate & Denial Dollars
Appeal Success Rate
Payment Posting Accuracy
Underpayment Identification
Patient A/R
Insurance A/R
Revenue Leakage
Authorization Accuracy
Coding Accuracy
Outstanding Insurance Follow-up
Provider Productivity
Payer Performance

Performance Reporting

Structured KPI Reporting

VelanSync provides structured KPI reporting to give healthcare organizations visibility into financial and operational performance.

Weekly Performance Review

WPR

  • Charges
  • Collections
  • A/R movement
  • Denials
  • Aging trends
  • Payer performance
  • Operational exceptions

Monthly RCM Performance Review

Monthly Review

  • KPI trends
  • Benchmark comparison
  • Revenue opportunities
  • Denial root-cause analysis
  • A/R recovery performance
  • Process improvement recommendations

Our Objective

Benchmarking as a Continuous Improvement Framework

Our goal is not simply to meet a benchmark. We use benchmarking as a continuous improvement framework to help healthcare organizations improve revenue-cycle performance.

Reduce A/R

Prevent Denials

Accelerate Collections

Minimize Revenue Leakage

Improve Financial Performance

Ready to Improve Your RCM Performance?

See how measurable RCM performance objectives can help identify opportunities across your revenue cycle.

Benchmarking Disclaimer

MGMA provides industry benchmarking data and comparative performance insights rather than universal mandatory standards. Performance benchmarks may vary based on specialty, practice size, payer mix, geographic market, ownership structure, technology environment, and other operational factors. VelanSync's internal targets are designed as performance objectives and may be customized based on each client's specific revenue-cycle requirements.