Get Practice Insider free
Join independent practice owners reading it every week. Enter your email and the next issue lands in your inbox.
No spam. One email a week. We never sell your address.
Issue 8 · July 2026
The dashboard number that tells you how fast your money actually comes in — and the malpractice bill you only see when you leave
Before you act on any number here: Practice Insider gives general operational guidance on running an independent practice. It is not legal, compliance, tax, insurance, or financial advice. Confirm any billing, coding, payer-contract, or insurance step with qualified healthcare counsel, your malpractice carrier or broker, a certified professional coder, or your own advisor before acting on it.
The lead: the one number that tells you how fast your money actually comes in
Net collection rate tells you how much of what you are owed you eventually bring in. It does not tell you how long that money takes to arrive — and a practice can collect 96% of its billings and still run short on cash every month because the money shows up 70 days after the visit. The number that measures speed instead of completeness is days in accounts receivable: the average number of days between billing a claim and getting paid for it.
Healthy days in A/R for an independent practice runs under 40; better performers land closer to 30 to 35. Cross 50 and money is sitting still somewhere — in a claim-hold queue, an unworked denial, or a patient balance nobody is chasing. Pair it with one more cut: the share of your total A/R that is more than 90 days old should stay under roughly 15% to 20%. A fat over-90 bucket is where receivables go to quietly die.
Days in A/R is easy to flatter by writing off aged balances, so read it next to the over-90 percentage rather than on its own. The two together tell the real story: a low days-in-A/R number with a growing over-90 bucket means the fresh claims are getting paid while the old ones rot. That is the pattern that comes before a cash crunch, and it shows up on the aging report months before it shows up in the bank account.
How to read it this month
Most practice-management systems calculate days in A/R for you; if yours does not, divide your current total accounts receivable by your average daily charges over the trailing three months. Then pull an aging report and read the over-90 column as a share of the total. If days in A/R is above 50 or the over-90 bucket is above 20%, the fix is almost never a new system — it is a standing weekly routine that works the oldest claims first, clears claim-holds before they age, and follows up on denials inside a fixed window rather than whenever someone finds the time.
Quick hits
Scheduling: the no-show rate that quietly caps your revenue
A no-show is not a delay — it is a slot that can never be resold, and the revenue for it is gone the moment the appointment time passes. No-show rates commonly run 5% to 15%, higher in some specialties and patient populations, and every point of that is capacity you already paid for in rent and payroll but never billed. On a schedule of 30 patients a day, a 10% no-show rate is three empty slots daily; at a typical established-patient reimbursement of roughly $75 to $150, that is a few hundred dollars a day walking out the door before it arrives. The fixes are unglamorous and they work: a reminder sequence that reaches the patient more than once, a same-day waitlist to backfill cancellations, and a written policy for chronic no-shows. Track the rate by provider and by day of week — the pattern usually points straight at the fix.
Insurance: the malpractice bill you only see when you leave
Most physicians carry a claims-made malpractice policy, which covers claims only while the policy is active. The moment you switch carriers, retire, or close the practice, that coverage stops — and any claim filed afterward for care you already delivered is uncovered unless you buy tail coverage. Tail, formally an extended reporting endorsement, commonly costs about 1.5 to 2 times your annual premium and sometimes more, and it comes due exactly when cash is tightest: at a transition. Two things soften it. Ask whether an incoming carrier offers prior-acts, or nose, coverage, which picks up your history and can make tail unnecessary; and check whether your current policy provides free tail on retirement after a set number of years or at a certain age. Know the number before you plan any move, not after you have already given notice.
Contracts: the payer agreement that never gives you a raise
Most commercial payer contracts are evergreen: they renew automatically, with no built-in rate increase and no expiration date to force a conversation. Left alone, your allowables can sit at the same numbers for years while rent, wages, and supply costs climb — a quiet pay cut every year inflation runs. Two habits fix it. First, calendar a fee-schedule review request on each contract's anniversary and actually send it; payers rarely raise a rate you do not ask about, and the ones worth the effort are your top three or four by revenue. Second, find and note each contract's termination-notice window, commonly 90 to 120 days, so you keep the standing to renegotiate credibly instead of discovering you missed the only exit for another year. You cannot negotiate a contract you cannot find, so pull them into one folder before anything else.
Putting this issue to work
Working aged claims and denials on a fixed cadence is exactly what a strong billing or RCM service is supposed to do — so if your days in A/R is climbing, it is worth pressure-testing whether your current billing operation can fix it or an outside one would do it better. Compare medical billing and RCM services on GetPracticeHelp and filter by your specialty and payer mix.
Compare billing services →On the numbers: days-in-A/R and over-90 aging benchmarks, no-show-rate ranges, malpractice tail-coverage multiples, and payer-contract norms reflect general medical-practice-management industry standards (MGMA-style benchmarking, AMA practice guidance, and payer-published contract terms). Your specialty, payer mix, carrier, and state will move the specifics — and tail-coverage cost in particular depends on your policy and specialty — so treat these as anchors to check against your own data and contracts, not guarantees.