Revenue cycle teams track dozens of metrics, but not all KPIs are created equal. As healthcare organizations head into 2026, the focus needs to shift from surface-level numbers to the measures that actually protect revenue and strengthen financial health.
Denials, delays, and write-offs are putting pressure on margins, and the right KPIs can reveal where money is slipping through the cracks and how to stop it.
The best place to start is with arguably the most urgent metric: your denial rate.
Denial Rate
The most urgent KPI heading into 2026 is your denial rate. Denials have become one of the most significant sources of preventable revenue loss across health systems, labs, and ASCs.
In recent years, insurers denied nearly one in five in-network claims, and providers spent almost $20 billion annually trying to recover that revenue. Even with that investment, organizations have still reported collecting less than half of what they’re owed from patients. That scale of loss isn’t sustainable.
However, for a truly holistic view of your denials management, tracking your denial rate alone is not enough. Organizations must dig deeper to turn data into action. Are prior authorization errors the main culprit? Eligibility? Medical necessity? Coding mistakes tied to a specific service line? Looking at denials in aggregate obscures these patterns.
Breaking them down by category, payer, and department helps leaders pinpoint root causes and implement targeted fixes, whether that means tightening front-end registration, updating documentation protocols, or retraining staff on specific coding rules.
As payer AI tools continue to accelerate denials, this KPI is critical for moving from a reactive posture to a proactive one. Denial rates above 15% are widely considered a red flag, but even lower percentages can mask significant revenue loss if the same categories keep recurring.
Days in AR
Days in AR remains the gold standard for assessing how efficiently revenue is being converted into cash. The longer receivables sit on the books, the less likely they will be collected, making this metric an early warning system for bottlenecks.
Strong performers tend to keep this figure in the 30–40-day range, though payer mix and specialty can shift that benchmark. When numbers climb higher, it often signals problems with claim submission timeliness, denials, or unresolved underpayments. Again, breaking this KPI down by payer and service line gives organizations a clearer picture of where delays originate.
90+ Days Insurance AR %
Once insurance balances age beyond 90 days, the probability of collection drops sharply. A high 90+ percentage usually indicates systemic issues, such as incomplete documentation, coding errors, or inefficient appeals workflows.
For revenue cycle leaders, this metric is a powerful way to identify which payers consistently drive delays. Tracking it at the payer level not only highlights process breakdowns but also creates leverage for renegotiating contracts or rethinking escalation protocols with payers that repeatedly underperform.
90+ Days Patient AR Percentage
Patient responsibility has become one of the most significant pressures on revenue cycles. Balances that sit unpaid for more than 90 days are difficult to recover and often point to weaknesses in upfront collections, financial counseling, or billing clarity.
In many organizations, patient AR is rising faster than insurance AR, especially with the continued prevalence of high-deductible health plans. When bills are incorrect or insurance unexpectedly denies coverage for a portion of care, patients are more likely to refuse payment.
From their perspective, they shouldn’t be responsible for a charge they don’t understand or believe should have been covered. That means what looks like a collections problem may actually be rooted in billing accuracy and communication.
Watching this KPI closely can reveal whether the patient’s financial experience is working or whether confusion and frustration are stalling payments. Clear communication, transparent estimates, and point-of-service payment options can reduce balances in this bucket and help rebuild patient trust in the billing process.
Net Collection Percentage
Net collection percentage is the truest measure of an organization’s ability to capture revenue it is entitled to. Unlike gross collection rates, which can be misleading, this metric compares actual collections against expected reimbursements based on contracts.
Anything less than 100% signals preventable revenue leakage. Low net collection rates may stem from underpayments, denials, or excessive write-offs, making this KPI essential for uncovering where revenue is slipping through the cracks. Monitoring it consistently provides a baseline for financial integrity and highlights opportunities for recovery.
Fully Written Off as a Percentage of Net Revenue
Write-offs are often treated as the cost of doing business, but when they climb too high, they represent real, preventable loss. Tracking write-offs as a percentage of net revenue helps organizations distinguish between contractual adjustments that are expected and unnecessary losses due to errors or process failures.
If this percentage grows over time, it may be tied to avoidable factors like missed appeal deadlines, incorrect coding, or ineffective denial management. Tracking this KPI keeps revenue integrity front and center and ensures avoidable losses don’t get buried in routine reporting.
DOS vs. DOE (Date of Service vs. Date of Entry)
The lag between the date of service and the date of entry into the billing system may not get as much attention as AR metrics, but it has a significant downstream impact.
The longer it takes for services to be entered, the greater the risk of missing timely filing deadlines and triggering denials. Shortening this gap can improve revenue predictability and reduce administrative burden by cutting down on rework. For labs, ASCs, and health systems, where volumes can be high and coding can be complex, monitoring this KPI is a way to safeguard against preventable delays.
Fully Adjusted Off CPTs Percentage
Certain CPT codes are more prone to denials or adjustments, whether because of payer-specific rules, documentation requirements, or coding complexities.
Tracking the percentage of fully adjusted off CPTs can reveal hidden vulnerabilities in coding practices. If particular codes consistently result in adjustments, that’s a signal to review documentation protocols, update coding practices, or engage with payers on clarification.
Paid Percentage 60+ Days
Another critical lens into payment timeliness is the percentage of claims paid after 60 days. While some lag is expected depending on payer processes, consistently high percentages here point to inefficiencies or payer-related slowdowns.
Viewing the trend of this KPI allows organizations to see whether delays are isolated incidents or part of a larger problem. Pairing this measure with denial data can help clarify whether long payment cycles are the result of disputes or simply sluggish payer operations.
Turn KPIs Into Action
Every one of these KPIs offers a lens into your organization’s financial health. But simply knowing these benchmarks isn’t enough; you need a way to track them consistently, break them down by payer and category, and uncover the root causes behind the numbers.
That’s why our opportunity assessment is so valuable. We report on, benchmark, and analyze these exact KPIs to give you a complete picture of your revenue cycle. From there, we identify where revenue is slipping, where processes can be tightened, and where the biggest opportunities for improvement lie.
Want full visibility into how your organization measures up across the KPIs that matter most? Request your opportunity assessment.
