GITNUX MARKETDATA REPORT 2023
Must-Know Medical Billing Performance Metrics
Highlights: The Most Important Medical Billing Performance Metrics
- 1. Clean Claims Rate
- 2. First Pass Resolution Rate
- 3. Denial Rate
- 4. Days in Accounts Receivable (A/R)
- 5. Collection Rate
- 6. Aging A/R
- 7. Credit Balance Percentage
- 8. Net Collection Ratio
- 9. Claim Turnaround Time
- 10. Payer Mix
- 11. Patient Financial Responsibility Rate
- 12. Unbilled Claims
- 13. Underpayments
Table of Contents
Medical Billing Performance Metrics: Our Guide
Efficient medical billing is a critical aspect of healthcare services, and understanding key performance metrics can significantly enhance this process. Our recent study dives deep into those metrics that can transform your approach towards medical billing. Today, we shall explore these must-know performance metrics that can optimize your medical billing process, improve recovery rates and reduce administrative errors.
Clean Claims Rate
The percentage of claims that pass through the billing process without requiring any manual intervention or re-submission.
First Pass Resolution Rate
The percentage of claims that are paid on their first submission without any denials or rejections. A high first pass resolution rate indicates efficient claim processing.
The percentage of claims that are denied or rejected by the payer. A low denial rate indicates a high level of claims accuracy and compliance with payer requirements.
Days In Accounts Receivable
The average number of days it takes for a practice to collect payment from a payer. A lower number indicates faster collections and better cash flow.
The percentage of billed charges that are collected by the practice. A higher collection rate indicates a more effective billing and collections process.
The percentage of outstanding receivables that are overdue, typically categorized in 30-, 60-, 90-, or 120-day brackets.
Credit Balance Percentage
The percentage of credit balances in comparison to total A/R. Ongoing monitoring of credit balances, including refunds, is essential for accurate financial management and compliance.
Net Collection Ratio
The ratio of actual payments received to the total amount of payments expected, showing how much revenue a practice collects out of the amount it is contracted to receive.
Claim Turnaround Time
The average time it takes for a submitted claim to be paid by the payer. A shorter claim turnaround time indicates a smoother billing process and better cash flow management.
The mix of different insurance payers that contribute to a practice’s revenue. Understanding payer mix can help identify high and low performing payers.
Patient Financial Responsibility Rate
The percentage of total practice revenue that comes from patient payments, such as copays, deductibles, and self-pay.
The value of claims that have not yet been submitted to payers due to errors, incomplete information, or other issues.
Frequently Asked Questions
What are Medical Billing Performance Metrics?
Why are Medical Billing Performance Metrics important?
What are some key Medical Billing Performance Metrics?
How can healthcare providers and medical billing companies improve their Medical Billing Performance Metrics?
How do Medical Billing Performance Metrics impact patient satisfaction?
How we write these articles
We have not conducted any studies ourselves. Our article provides a summary of all the statistics and studies available at the time of writing. We are solely presenting a summary, not expressing our own opinion. We have collected all statistics within our internal database. In some cases, we use Artificial Intelligence for formulating the statistics. The articles are updated regularly. See our Editorial Guidelines.