Category: Data & Analytics

The Average Time Medicare Claims Processing Takes For Clean Claims

Posted on February 8, 2021March 18, 2026 by Jd Medlink

One of the most common questions we receive from clients is: “How long should it take to get paid by Medicare?” The answer depends on your specialty, your MAC jurisdiction, and whether your claims are truly clean when submitted.

## Our Data: 10,100 Medicare Claims

We analyzed 10,100 Medicare claims submitted by MedLink clients across multiple specialties. Here is what the data showed:

**Overall Average: 14.02 days from submission to payment**

A few observations from this data:

– **Podiatry** consistently processes fastest. This is likely due to simpler coding patterns and lower denial rates for common procedures.
– **OB/GYN and Orthopedics** are the slowest. Both specialties involve complex procedures with higher rates of medical necessity reviews and authorization requirements.
– **Family Practice** falls near the middle, which aligns with the mix of E/M services and preventive care that typically have straightforward adjudication.

## Blue Cross Data: 11,700 Claims Across 6 States

We also analyzed 11,700 Blue Cross claims across six states. The key finding: **payment variance of 6.07 days** between the fastest and slowest state.

This variance is significant and is primarily driven by:
– State-specific claims processing infrastructure
– Local plan policies and medical necessity criteria
– Provider-specific contract terms

## What Makes a “Clean” Claim?

A clean claim is one submitted without errors or missing information that would cause the payer to request additional information before processing. The key elements of a clean claim include:

1. Accurate patient demographics (name, DOB, insurance ID)
2. Correct provider NPI and taxonomy code
3. Valid and supporting diagnosis codes (ICD-10)
4. Appropriate CPT codes with modifiers if required
5. Place of service code matching the actual service location
6. Referring provider information when required

In our experience, the majority of claims that extend beyond 30 days are not actually being processed slowly — they were never truly clean when submitted.

## What Should You Do If Claims Are Taking Longer?

If your Medicare claims are regularly exceeding 20–25 days, investigate:

– Are claims being submitted within 24–48 hours of service?
– What is your clean claim rate at your clearinghouse?
– Are you tracking denials back to root causes?

MedLink’s standard is 48-hour claim filing. If you want to benchmark your practice against these numbers, reach out for a free revenue cycle review.

Medical Practice Aging | How Does My Practice Compare With My Peers

Posted on January 25, 2021March 18, 2026 by Jd Medlink

When a practice wants to understand the health of its revenue cycle, the insurance aging report is the first place to look. But reading that report — and knowing what “good” looks like — requires context.

## The 3 Components of Insurance Aging

Every aging report you generate from your practice management system should break down each payer’s balance into three components:

1. **Charge** — The amount billed to the insurance company
2. **Contractual Adjustment** — The portion of the charge that has been written off per your contract with the payer
3. **Payment** — What the payer has actually paid

The net balance remaining (Charge minus Adjustment minus Payment) is your outstanding AR. This is the number that matters.

## What Are the Benchmarks?

Benchmarks vary depending on the source, but here are two commonly referenced standards:

**MGMA (Medical Group Management Association)**
MGMA data suggests that a healthy practice should have approximately **57% of insurance AR in the current bucket** (0–30 days).

**Collection Agency Standard**
A more aggressive benchmark — often used by revenue cycle consultants — is **62% current**.

The gap between 57% and 62% might seem small, but at scale, it represents meaningful dollars. A practice with $500,000 in monthly charges that improves its current percentage from 57% to 62% is collecting an additional $25,000 per month faster.

## Why Benchmarks Are Subjective

Raw aging benchmarks have a flaw: they are influenced by your fee schedule. If your charges are set too low (at or near Medicare reimbursement rates), the contractual adjustment column will be small — making your aging look healthier than it actually is.

**Best practice for fee schedule pricing:** Set your fees at **120–150% of Medicare reimbursement**. This ensures:
– You have room to accept commercial payer contracts at market rates
– Your aging report accurately reflects true payer behavior
– You are not inadvertently leaving money on the table with non-contracted payers

## How to Use This Data

When reviewing your aging report, ask:

– **What percentage of my AR is over 90 days?** Anything over 15–20% warrants investigation.
– **Which payers have the most aging over 60 days?** These are your denial problem payers.
– **Is my fee schedule masking true collection problems?** Run a comparison against Medicare fee schedules.

## Bottom Line

Aging reports are a window into the health of your revenue cycle. If you do not have a clear picture of where your AR stands relative to industry benchmarks, start there. It is the foundation of every other improvement you will make.

Need help reading your aging report or setting up benchmarks? Contact MedLink Services for a free revenue cycle review.

Medical Accounts Receivable Audit | 5 Metrics They Should Uncover In An Audit

Posted on November 19, 2019March 18, 2026 by Jd Medlink

When practices come to us after switching billing companies or after a period of internal billing, an AR audit is always the first step. These are the five metrics we look for — and what they reveal about a practice’s billing health.

## Metric 1: 85% of AR Should Be Under 90 Days Old

This is the primary benchmark for a healthy practice. If more than 15% of your total AR sits beyond 90 days from the **date of service**, you have a systemic collection problem.

Common causes of excessive AR over 90 days:
– Claims not submitted timely
– Denial management is reactive rather than proactive
– Insufficient follow-up on aging balances

*Note: Always measure from date of service, not date of billing. Date of billing can be manipulated and does not reflect true payer performance.*

## Metric 2: 40% of Blue Cross Patient Balance Under 90 Days

Blue Cross (and other major commercial payers) moves quickly when claims are clean. If less than 40% of your Blue Cross patient balance is in the current bucket, investigate your claim submission quality for that payer.

Blue Cross typically processes clean claims in 7–14 days. If you are seeing 30+ day payment timelines on Blue Cross, there is likely a contract, credentialing, or claim quality issue to resolve.

## Metric 3: Reimbursement Comparison to Like Providers

An AR audit should benchmark your reimbursement rates against your peers — practitioners with the same specialty, in the same geographic market.

This comparison reveals:
– Whether your payer contracts are competitive
– Whether coding patterns are consistent with peers
– Whether there are payers systematically underpaying based on contract terms

If you are being paid 15–20% below your specialty peers for comparable services, you likely have a fee schedule or contract negotiation issue.

## Metric 4: Days in AR Calculation

Days in AR is one of the most important single-number metrics in medical billing. It measures how many days, on average, it takes to collect a dollar of charges.

**Formula:**
Days in AR = Total AR Balance ÷ (Average Daily Charges)

Where Average Daily Charges = Total Charges over 90 days ÷ 90

**Industry benchmarks:**
– Primary care: 30–40 days
– Specialty practice: 40–55 days
– Surgical specialties: 45–65 days

If your days in AR exceeds your specialty benchmark, billing lag and denial rates are the most common culprits.

## Metric 5: Healthy Aging Buckets Across All Payers

Beyond the 90-day metric, a full aging analysis should show:

| Bucket | Target % |
|——–|———-|
| 0–30 days | 50%+ |
| 31–60 days | 20–25% |
| 61–90 days | 10–15% |
| 90+ days | Under 15% |

Any payer where the 90+ day bucket exceeds 20% deserves immediate attention.

## The Date of Service vs. Date of Billing Issue

We see this frequently in audits: practices that measure aging from **date of billing** rather than **date of service**. This creates a false picture of AR health. If your billing team submits claims 10–15 days after service, your aging report will look better than it actually is.

Always measure from date of service. Always.

## What to Do With the Audit Results

Once you have these five metrics in hand, prioritize:
1. Fix the highest-value payers with the most aging over 90 days first
2. Address root causes (not just symptoms) — denial codes, credentialing issues, authorization failures
3. Establish a monthly cadence for reviewing all five metrics

An audit is only valuable if it leads to action. If you would like MedLink to conduct a complimentary AR audit for your practice, contact our team.