June 27, 2025 – RCAceSolutions

By RCAceSolutions | Revenue Growth Partner

Your billing partner proudly reports a 95% collection rate. Sounds like cause for celebration, right?
Not so fast.
That number might be the exact reason you’re stuck… while other practices leap ahead.

🚨 The Collection Rate Trap

Let’s get real. A 95% collection rate only tells one side of the story—it shows how much you’re collecting based on what was billed.
But what if you’re not billing for everything you should be?

According to recent MGMA research, collection rate is a lagging indicator. It doesn’t measure whether your practice is maximizing its full earning potential. It just tells you how well you’re cleaning up the leftovers.

💡 What’s Hiding Behind That “95%”?

New data from the Healthcare Financial Management Association (HFMA) and other sources reveals something that should make any practice owner pause:

Even with a 94%+ collection rate, most practices leave 20–40% of potential revenue on the table
The highest-growth practices measure “revenue per encounter”—not just collection percentages
Strategic RCM approaches outperform “efficient” billing operations by an average of $1.2M annually

🔍 Where Are You Losing Money?

Let’s break it down.

1. Coding Complexity Blind Spots

67% of clinics under-code by 1–2 levels, per AAPC research
That’s about $280,000/year in lost revenue—just from misused E/M codes
Why? Because it’s “safer” and easier for billers who aren’t trained to optimize coding strategically

2. Payer Contract Complacency

78% of practices have contracts reimbursing below market rate
65% never renegotiate them
This adds up to a shocking $450K+ in preventable underpayments every year

3. Playing It Safe With Services

High collection rates often mean you’re avoiding complex, higher-value services
Practices that expand or rebalance their service mix see 23% revenue growth, according to The Advisory Board

✅ What You Should Be Tracking Instead

Let’s toss the vanity metrics and upgrade to Revenue Intelligence KPIs that actually drive growth:

❌ Stop Tracking	✅ Start Tracking
Overall collection rate	Net collection by procedure, payer, and provider
Days in A/R	A/R aging tied to denial reasons and resolution time
Clean claim rate	First-pass resolution rate + Denial prevention metrics

🧠 RCM Strategy = Asking Smarter Questions

If you’re only looking at collections, you’re managing the past.
If you’re thinking strategically, you’re optimizing the future.

Ask:

“How can we ensure the right services are coded at the right complexity?”
“Which payers are underpaying us—and how do we fix that?”
“What untapped services are we missing out on?”

🚀 Strategic Practices Grow Faster

A study from Healthcare Strategy & Operations revealed:

Traditional Billing Focus	Strategic RCM Focus
3–8% annual growth	15–30% annual growth
18 months to see impact	90 days for measurable results
Efficiency-based KPIs	Revenue-based KPIs

Strategic RCM isn’t just better. It’s faster, smarter, and far more profitable.