1Net days in accounts receivable

This is the average number of days it takes to turn billed services into cash. HFMA's MAP Key FM-1 divides net A/R by average daily net patient service revenue. Billing consultancies commonly cite a target range of 30 to 40 days for ambulatory practices, with the best performers at 25 or fewer.

One caution: the figure falls when a billing office writes off balances quickly, so a falling number can mean faster collection or faster surrender. Read it next to metric 3.

2A/R over 90 days

Take the dollars aged past 90 days and divide by total A/R. A common target is below 15%, and many practices also watch the 120-day bucket. Cardiology tends to accumulate old balances in two places: unresolved denials on imaging, and secondary claims waiting on a primary payer's remittance.

Segment this by payer. A single slow commercial plan can account for most of the old balance.

3Net collection rate

Collections divided by the amount owed after contractual adjustments. Suppose a practice bills $2,000,000, expects $1,100,000 after contractual allowances, and collects $1,056,000. The net collection rate is 96%. Sources citing the Medical Group Management Association (MGMA) place the benchmark above 95%.

A result below that range usually points to preventable write-offs, not a contract problem.

4Charge lag

The days between date of service and charge entry. Medicare's timely filing limit is one calendar year from the date of service, so the real risk is not Medicare. It is the commercial plans with 90-day windows, where a cath lab charge that sits unreconciled for three weeks eats a quarter of the allowance.

No single published benchmark covers cardiology. Most groups set an internal ceiling (many choose two to three business days for office services) and review exceptions weekly.

5Clean claim rate

The percentage of claims accepted by the payer on first submission, with no edits or manual touches. Targets published by billing vendors usually begin at 95%. Track rejections at the clearinghouse separately from denials at the payer, because the fixes belong to different teams. Rejections are usually demographic or formatting errors. Denials usually involve coding or medical necessity.

6Initial denial rate

MAP Key AR-5 defines the remittance denial rate as the share of claims, by volume or dollars, that a payer denies on first adjudication. If 80 of 1,000 submitted claims are denied, the rate is 8%. Many sources set a target under 5%.

Break it down by reason code. Missing authorization, medical necessity, and bundling edits behave differently in cardiology than in primary care.

7Denial write-offs

MAP Key AR-6 measures dollars written off because of denials as a percentage of net patient service revenue. It separates denials a practice recovers from those it abandons. Two practices with identical denial rates can have very different write-off rates if one appeals and the other does not.

8Appeal overturn rate

Dollars recovered on appeal divided by dollars appealed. Track it by payer and denial reason. A payer that overturns 70% of echo medical-necessity appeals but only 20% of bundling appeals tells the team where to spend its hours. If a low overturn rate persists for one reason code, the problem sits upstream, in documentation or coding.

9Authorization-related denial rate

Advanced imaging such as nuclear stress testing (for example CPT 78452) and some echocardiography are subject to prior authorization or radiology benefit management review under many commercial and Medicare Advantage plans. Count denials coded as no authorization, expired authorization, or mismatched CPT code against the authorization on file, and divide by total denials and by total claims for authorized services.

A mismatch is the common variant: the order was approved for one code and the performed study billed under another.

10In-office diagnostic charge capture

Practices that own their equipment bill a technical component (modifier TC) and a professional component (modifier 26), or a global charge when both are performed by the same entity. Reconcile the number of studies performed (from the echo or nuclear lab's own log) against the number of charges billed. A gap of even 2% in a busy lab is a recurring revenue loss, since each missed study is simply unbilled.

This audit rarely appears in generic RCM dashboards, which is why it belongs here.

11Point-of-service collection rate

HFMA tracks point-of-service cash collection as a MAP Key. For cardiology, the concern is high-deductible plans: a patient with a $3,000 deductible who undergoes a nuclear study owes a sizable balance that grows harder to collect after discharge. Measure the share of estimated patient responsibility collected at or before the visit.

12Payer yield against Medicare

Express each commercial contract as a percentage of the Medicare fee schedule for your top 20 CPT codes. Because Medicare's 2026 non-APM conversion factor is $33.4009, a contract tied to a percentage of Medicare moves when CMS moves, while a fixed-dollar contract does not. Compare actual paid amounts to contracted rates monthly. Underpayments of a few percent are common and rarely noticed without a line-level audit.