OTLEN / Top
Benchmarks · frameworks · best practices · tool selection
https://otlen.top/
A reference shelf for better revenue systems.
Benchmarks, frameworks, best practices and curated tools for revenue cycle and revenue operations leaders at health systems, clinic groups and med spas.
The internet is full of lists. Most are not useful enough to change behavior. Here, every benchmark, framework and recommendation has a reason, a context and a practical reading. Every chart names its baseline, its period and its public source, and every figure traces back to the file it came from.
Bad debt at cost a year, by hospital size, ranked
CMS cost reportsBaselinenet patient revenue of each groupPeriodcost reports for fiscal years beginning Oct 2022 to Sep 2023DataCMS hospital cost reports (HCRIS), 4,505 short-term acute and critical access hospitals; bad debt at cost from Worksheet S-10 line 29Drawingtower height on a square-root scale of net patient revenue; the green roof band is bad debt as a share of it
- 01BenchmarksDays in A/R, bad debt and margin for 4,505 hospitals, against five peer sets.
- 02Frameworks84.5 million denied claims in one year. Rank insurers by volume, then by how often appeals win.
- 03Best practicesWho pays for each inpatient day changes the first move, by size of hospital.
- 04Tool selectionEight administrative transactions ranked by how much is still worked by hand.
A number means little until you name its baseline.
A benchmark is useful only when the measurement has context. Days in A/R, bad debt, margin and denial rate should be compared against a meaningful peer set rather than treated as impressive numbers by themselves. Across more than 2,100 hospitals, Kodiak Solutions measured an initial denial rate of 11.81% in 2024, up from 10.15% in 2020; your own rate means something only next to the right peers.
The national median hospital, placed in each peer set
CMS cost reportshospitals in this peer set, fiscal 2023 cost reports
Baselineselectable peer set: bed count from Worksheet S-3, critical access hospitals by CMS certification numberPeriodfiscal years beginning Oct 2022 to Sep 2023DataCMS hospital cost reports (HCRIS), form 2552-10Methoddays in net A/R = Worksheet G lines 4 and 6 ÷ (G-3 line 3 ÷ 365); bad debt at cost = S-10 line 29 ÷ G-3 line 3; margin = G-3 line 5 ÷ G-3 line 3; figures as reported; values beyond an axis sit in its end cell
Denial reasons reported by HealthCare.gov insurers, 2019 to 2024
CMS · KFF methodA baseline has a time axis too. Stream height is the denial reasons insurers reported each year; one claim can carry more than one. From 2022, CMS asks insurers to report administrative, benefit-limit and member-not-covered reasons on their own instead of inside Other.
Baselineevery denial reason reported, out-of-network denials excludedPeriodplan years 2019 to 2024DataCMS Transparency in Coverage public use files, individual-market plansMethodfollows KFF’s marketplace denial analysis
A framework should end in an action.
Frameworks should simplify decisions. A good framework tells you what to look at, what trade-offs matter, and what action follows. It should be possible to use it without memorizing a textbook.
Rule one: work the payers that deny the most, first
CMS PUF · 2022–2024Baselineeach year’s national in-network denial ratePeriodplan years 2022 to 2024DataCMS Transparency in Coverage public use files, insurers with more than 1,000 in-network claims in the 30 states on HealthCare.gov in 2024
Rule two: then sort by how often appeals win
CMS PUF · 2022–2024Each hexagon counts insurer-years with a similar volume of denied claims and a similar share of internal appeals overturned. The dashed lines split them into four actions.
Baselineinsurer-years with 30 or more internal appealsSplit100,000 denied claims; half of appeals overturnedDataCMS Transparency in Coverage public use files, plan years 2022 to 2024; cost and recovery figures from Premier Inc., 516 hospitals, 2022 claimsNotemarketplace appeals are filed by enrollees; provider appeals are not reported
Best practice depends on who is practicing.
Best practices are conditional, not universal. What works for a multi-location med spa group may be wrong for an academic medical center, and a hospital paid mostly by Medicaid needs a different first move than one paid mostly by Medicare. Each recommendation here explains when a pattern applies and when it does not.
Who pays for each inpatient day, by size of hospital
CMS cost reportsEach building is drawn in strata. From the ground up: commercial, self-pay and other; Medicaid; Medicare Advantage; traditional Medicare, each band as tall as its share of inpatient days.
Baselinetotal inpatient days of each group, 100%Periodfiscal years beginning Oct 2022 to Sep 2023DataCMS hospital cost reports (HCRIS), Worksheet S-3 Part IMethodMedicare and Medicaid days from line 14; Medicare Advantage and Medicaid managed care from the HMO line
Rank tools by the job, not the demo.
The best tool depends on the workflow, constraints, data, team, and economics. Start where work is still done by hand: the CAQH Index measures how much of each administrative transaction is fully electronic, what a manual transaction costs, and how much the industry could still save.
Eight transactions, ranked by the share not yet fully electronic
CAQH Index 2025Scaleshare of transactions conducted fully electronically, reported by health plans; dot size follows the shareEditions2023, 2024 and 2025 CAQH Index; the 2025 edition reflects 2024 activityData2025 CAQH Index Executive ReportNotedental prior authorization is not measured; dental coordination of benefits was not reported in 2025
Every figure, traced to its file.
OTLEN tabulated the CMS files directly. The same method reproduces KFF’s published 2023 marketplace figures: 435,990,474 in-network claims, 85,894,625 denied, 175 insurers and 376,508 internal appeals.
- 01CMS, Transparency in Coverage public use files
Plan years 2019 to 2024; individual-market qualified health plans in HealthCare.gov states
Denial reasons stream, insurer ranking, appeals map
- 02KFF, Claims denials and appeals in ACA Marketplace plans in 2024
With the 2023 edition: method, exclusions and published totals
Method and cross-check
- 03CMS, Hospital cost reports (HCRIS), form 2552-10
Fiscal 2023 release; 4,505 short-term acute and critical access hospitals
Bad debt towers, benchmark grid, payer mix buildings
- 04CAQH, 2025 CAQH Index Executive Report
More than 600 provider organizations and health plans covering 63% of insured lives
Transaction ranking, cost per transaction, savings
- 05Premier Inc., Trend alert on private payer denials
Mar 21, 2024; 516 hospitals in 36 states, claims from calendar 2022
Cost to work a denial, share overturned, annual cost
- 06Kodiak Solutions, revenue cycle benchmarks
May 21, 2025; more than 2,100 hospitals
Initial denial rate, 2020 and 2024
Good recommendations explain the trade-off, not just the choice.
The standard
The goal is not to create an authority voice that says what everyone should do. It is to make good comparisons easier, surface the reasoning behind them, and help revenue leaders reach decisions with less wasted research.
Figures come from public files and published research, linked under Sources. Recommendations are editorial and say so.