Specialities
Services
Resource Center
Pricing
About
Contact
The right target depends on your payer mix and baseline, which is why the contract should guarantee improvement against a signed baseline rather than a generic number. Require NCR reported separately for obstetric and gynecologic services, since blended rates can hide global package underperformance behind stronger surgical collections.
Your OB-GYN billing partner should guarantee five contract-defined metrics: net collection rate, AR over 90 days, first-pass resolution rate, vendor-caused timely filing write-offs, and delivery-to-global-claim lag, each measured against a documented baseline with a financial remedy attached.
Most billing agreements promise "improved collections" and define nothing. That gap is where OB-GYN revenue quietly disappears.
The Problem With Most Billing Guarantees
Vendors rarely refuse to share metrics. They refuse to define them.
A "98% clean claim rate" can mean claims accepted by the clearinghouse, which only confirms formatting. It says nothing about whether the payer paid. A "collections increase" with no baseline can reflect higher patient volume rather than better billing.
For OB-GYN groups, the stakes are sharper. Global maternity revenue arrives months after care begins, so a vendor can look strong on monthly dashboards while antepartum revenue ages out of filing windows. As we covered in how global maternity billing hides revenue loss [link pending publish], that loss never appears as a denial.
The fix is contractual, not operational: every guaranteed metric needs a formula, a baseline, a measurement window and a consequence.
The Five Metrics Worth Guaranteeing
1. Net Collection Rate (NCR), split by OB and GYN.
NCR measures payments collected against what you were contractually owed: payments divided by charges minus contractual adjustments. Require it reported separately for obstetric and gynecologic services. A blended rate lets strong GYN surgical collections mask global package underperformance.
2. AR over 90 days as a percentage of total AR.
Days in AR can be improved by writing off old balances. AR over 90 days as a share of total receivables is harder to manipulate and exposes aging problems directly. Pair it with a rule that write-offs require documented practice approval.
3. First-pass resolution rate, defined at payer adjudication.
Insist the contract measures claims paid on first submission, not claims accepted by the clearinghouse. This single definition separates billing quality from formatting hygiene.
4. Zero vendor-caused timely filing write-offs.
A CO-29 denial caused by the vendor's delay is not a payer problem. With UnitedHealthcare's commercial in-network filing window at 90 days under its provider administrative guide, a late-billed antepartum component can be lost in one quarter. Contracts should make these write-offs vendor-liable.
5. Delivery-to-global-claim lag.
This is the OB-specific metric most agreements omit. Set a maximum number of days between delivery date and global claim submission (59400, 59510, 59610, 59618), plus a standard for switching to component billing when a pregnancy leaves the global chain.
Metrics to Track but Not Accept as Guarantees
Some numbers are useful but too easy to inflate, or depend on factors outside the vendor's control.
| Metric | Why It Fails as a Guarantee | Better Use |
|---|---|---|
| Gross collection rate | Distorted by chargemaster pricing | Ignore for performance evaluation |
| Clearinghouse acceptance rate | Measures formatting, not payment | Operational hygiene check only |
| Claims submitted per month | Rewards volume, not outcomes | Workload planning |
| Total collections growth | Driven by patient volume and payer mix | Report alongside NCR, never alone |
| Payer underpayment recovery | Depends on payer behavior | Require reporting on every remittance cycle |
How to Write the Guarantee Into Your Contract
A metric without terms is a marketing claim. Each guaranteed metric should specify:
- Definition source: use HFMA MAP Keys so formulas can't be redefined mid-contract
- Baseline: your trailing six months before transition, agreed in writing
- Ramp period: a defined transition window (typically the first 90 days) excluded from measurement
- Exclusions: payer system outages and documented provider documentation delays, listed specifically
- Reporting: monthly, segmented by payer, provider and CPT code, from data you own
- Remedy: fee credits or exit rights when targets are missed for consecutive months
| Contract Element | Weak Agreement | Enterprise-Grade Agreement |
|---|---|---|
| Metric definition | "Industry standard" | HFMA MAP Keys formula cited |
| Baseline | None | Trailing six months, signed off |
| Clean claim measure | Clearinghouse acceptance | Paid at first adjudication |
| Timely filing losses | Absorbed by practice | Vendor-liable when vendor-caused |
| OB global tracking | Not addressed | Delivery-to-claim lag with maximum days |
| Data ownership | Vendor portal only | Practice owns raw data and exports |
MBC Spotlight
MBC's OB-GYN billing services report every metric above through RCM analytics segmented by payer, provider and CPT code, managed by a dedicated RCM Principal. Our results set the bar to hold any partner to: a 97% clean claim rate, 30% A/R reduction within 90 days, 98% client retention and 25+ years of specialty experience.
Reviewing your current billing agreement? Request Your Free Revenue Diagnostic and benchmark your contracted metrics against your actual performance.
