Financial performance in healthcare depends heavily on how well billing processes are managed. For practice managers, reviewing the right monthly medical billing performance indicators helps avoid missed revenue, reduce operational delays, and support better business decisions.
A partnership with Medical Billers and Coders (MBC) structures this process through consistent reporting, proactive workflows, and a results-driven approach to revenue cycle management.
Why Billing Metrics Are Important?
Delays in charge capture, incomplete billing, and frequent denials can disrupt revenue flow and put long-term financial goals at risk. Focusing on a few core metrics helps uncover issues early and drive measurable improvement.
Monthly metric tracking helps to:
- Identify revenue delays and collection issues
- Track billing team productivity
- Spot recurring errors or missed charges
- Strengthen payer and patient collection efforts
- Stay aligned with payer and coding requirements
Billing Metrics to Review Monthly
Below are seven metrics that clearly show how well a healthcare organization manages its revenue cycle.
1. First Pass Resolution Rate (FPRR)
Definition: Percentage of claims paid by payers upon initial submission.
Why It Matters: High FPRR reduces administrative work, speeds up payments, and reflects claim accuracy.
Benchmark: 90–95%
How MBC Helps: MBC applies payer-specific edits and claim checks before submission, reducing rejections and rework.
2. Days in Accounts Receivable (A/R)
Definition: Reflects the average time it takes for payments to be received after services have been provided.
Why It Matters: Shorter A/R times mean faster cash flow. Extended Accounts Receivable often points to claim follow-up issues or unpaid balances.
Target: Under 35 days
MBC’s Approach: MBC organizes A/R into aging categories, prioritizes overdue claims, and manages consistent follow-up.
3. Net Collection Rate
Definition: Measures how much of the total collectible revenue is received.
Why It Matters: This number indicates how effectively the practice collects what it owes.
Benchmark: 95–98%
MBC’s Role: MBC reviews payment activity, manages underpayments, and initiates appeals where necessary to improve recovery rates.
4. Denial Rate
Definition: Percentage of total submitted claims rejected or denied by payers.
Why It Matters: Frequent denials usually point to documentation, coding, or authorization issues that must be addressed.
Benchmark: Below 5%
MBC’s Support: MBC reviews denial patterns monthly, provides insights, and corrects the sources of errors to reduce future issues.
5. Clean Claims Rate
Definition: The percentage of claims submitted without errors or the need for corrections.
Why It Matters: A higher clean claim rate leads to fewer delays and faster reimbursements.
Benchmark: 95% or higher
How MBC Contributes: Certified coders at MBC review claims thoroughly, reducing errors before submission and improving payer acceptance rates.
6. Patient Collection Rate
Definition: The portion of total patient-responsible balances that are successfully collected.
Why It Matters: With high out-of-pocket costs, collecting from patients is integral to overall revenue.
Target: 70–80%
MBC’s Method: MBC provides tools and processes that include real-time eligibility checks, patient payment options, and front-office support for cost estimates.
7. Charge Lag Time
Definition: Average time between the service date and when charges are entered into the billing system.
Why It Matters: Faster charge posting supports timely claim submission and improves overall revenue cycle timing.
Benchmark: 0–2 days
MBC’s Process: MBC enters charges daily and maintains a schedule to minimize posting delays and maximize billing accuracy.
What do Medical Billers and Coders (MBC) deliver?
A dependable medical billing service brings structure, visibility, and accountability to the revenue process. Medical Billers and Coders (MBC) helps practices manage every billing aspect clearly and consistently.
Services include:
- Certified coders with experience across multiple specialties
- Real-time reporting on billing and collection KPIs
- Monthly reviews of performance data and problem areas
- Denial tracking with corrective actions
- Dedicated A/R follow-up teams
- Reports that match the operational needs of each practice
Whether working with small groups or larger clinical operations, MBC supports healthcare providers with clear workflows and reliable data.
Conclusion:
Monitoring the proper billing metrics monthly allows practice leaders to make smarter decisions, recover lost revenue, and strengthen the billing process. Each of the seven KPIs shared above serves as a checkpoint for identifying risks and opportunities in the revenue cycle.
Medical Billers and Coders (MBC) help organizations stay focused on what matters: accurate billing, timely follow-up, and full revenue capture.
Looking for better billing visibility?
Contact MBC today for a detailed revenue cycle review and monthly performance insights.
FAQs
Answer: Reducing denials requires clean claim submission, proper coding, timely prior authorizations, and proactive denial tracking. Working with a billing company that provides denial analytics and payer-specific edits can significantly reduce rejection rates.
Answer: Key metrics include First Pass Resolution Rate, Net Collection Rate, Denial Rate, Days in A/R, and Clean Claims Rate. MBC provides monthly KPI dashboards and detailed reports to help healthcare providers monitor and improve billing outcomes consistently.
Answer: High out-of-pocket costs lead to payment delays or defaults without structured collection methods. MBC helps implement real-time eligibility checks, upfront cost estimates, and patient payment plans to improve collections.
Answer: Incorrect formatting, missing demographics, and invalid payer info are common. MBC uses claim scrubbers and front-end quality checks to eliminate such errors before submission.
Answer: EHR and PM system integration allows seamless charge capture and automated workflows. MBC integrates with major systems like eClinicalWorks, Athenahealth, NextGen, and others to streamline data transfer and minimize errors.
Answer: Full HIPAA compliance, accurate coding, secure data handling, and adherence to CMS guidelines are critical. MBC performs routine internal audits, compliance checks, and provides audit-readiness support.
