You can’t manage what you don’t measure. These four metrics tell you, at a glance, whether your revenue cycle is healthy. Each one points to a different part of the process when it slips.
1. Clean claim rate
Formula: claims accepted on first submission without edits ÷ total claims submitted.
A common target is 95% or higher. A low rate points to front-end and coding problems: registration errors, missing authorizations, modifier issues or payer-specific edits your claims aren’t passing.
2. Days in accounts receivable
Formula: total A/R ÷ average daily gross charges (total charges for the last 90 days ÷ 90).
Many practices aim for under 40 days, though it varies by specialty. Rising days in A/R usually means slow follow-up, unresolved denials or claim submission delays. Also watch the share of A/R older than 90 days; a common goal is to keep it under 15–20%.
3. Denial rate
Formula: claims denied ÷ claims submitted, for the same period.
A common benchmark is under 5%. Look beyond the total: track denial rate by payer, by reason code and by provider to find the root cause.
4. Net collection rate
Formula: payments received ÷ (charges − contractual adjustments).
This shows how much of the money you are actually owed you collect. Well-run practices often reach 95% or more. A low rate signals write-offs, underpayments or patient balances that never get collected.
Review them together, every month
| If this slips… | Look first at… |
|---|---|
| Clean claim rate | Registration, eligibility, coding edits |
| Days in A/R | Charge lag, follow-up cadence, open denials |
| Denial rate | Authorizations, medical necessity, payer rules |
| Net collection rate | Underpayments, write-off policy, patient collections |
Every ClaimEdge RCM Solutions LLC client receives a monthly report with all four KPIs. See how we manage the full revenue cycle.
