RCM Improvements
We measure, monitor, and optimize the KPIs that matter most to your practice's financial health. Here's how we turn underperforming metrics into measurable results.
Why KPIs matter in RCM
Revenue Cycle Management isn't just about submitting claims — it's about consistently measuring performance, identifying gaps, and driving improvement across every stage. The right KPIs provide a clear picture of your practice's financial health, while targeted improvements translate directly to increased revenue and reduced overhead.
Identify Revenue Leaks
KPIs expose hidden inefficiencies — from coding errors to slow follow-ups — that silently drain your revenue.
Benchmark Performance
Compare your practice against industry standards to understand where you stand and where you need to improve.
Drive Continuous Growth
Data-driven insights fuel ongoing optimization, ensuring your revenue cycle improves quarter after quarter.
Key Performance Indicators
The critical metrics we track, optimize, and improve for every client — driving measurable financial outcomes.
Clean Claims Rate
The percentage of claims that pass all edits and are accepted on the first submission without any rejections or errors.
Why It Matters
A low clean claims rate means more rework, delayed payments, and increased administrative costs. Every rejected claim costs an average of $25–$30 to rework.
How NEOMed Improves This
- Pre-submission claim scrubbing with automated edit checks
- Real-time eligibility verification before claim creation
- Certified coders ensuring accurate coding at first pass
- Proactive payer rule updates and compliance monitoring
- Root cause analysis on rejected claims to prevent recurrence
Days in Accounts Receivable (A/R)
The average number of days it takes to collect payment after a claim is submitted. Measures the overall efficiency of the revenue cycle.
Why It Matters
High A/R days indicate cash flow problems. Every day beyond 30 days A/R represents lost revenue potential and increased collection difficulty. Claims older than 90 days have less than a 50% chance of collection.
How NEOMed Improves This
- Aggressive follow-up on unpaid claims within 7–10 days
- Automated aging bucket monitoring and escalation workflows
- Strategic payer contract negotiations for faster reimbursement
- Electronic remittance and auto-posting for faster reconciliation
- Dedicated A/R recovery teams focused on aging accounts
Denial Rate
The percentage of claims denied by payers. Includes initial denials, partial denials, and claims requiring appeal to receive payment.
Why It Matters
The average healthcare organization loses 3–5% of net revenue to denials. Up to 65% of denied claims are never reworked, leaving significant money on the table.
How NEOMed Improves This
- Proactive denial prevention through front-end data validation
- Comprehensive denial tracking and categorization by root cause
- Timely appeal submissions with supporting clinical documentation
- Payer-specific denial trend analysis and corrective action plans
- Staff education on common denial triggers and prevention
Net Collection Rate
The percentage of total allowed amount that is actually collected. This is the truest measure of a practice's financial performance.
Why It Matters
A net collection rate below 95% signals systemic issues in billing, coding, or follow-up. Even a 1% improvement can translate to tens of thousands in additional revenue annually.
How NEOMed Improves This
- Comprehensive fee schedule analysis and optimization
- Underpayment identification and automated payer recovery
- Accurate charge capture with documentation-driven coding
- Patient payment responsibility education and easy payment options
- Contractual adjustment auditing to prevent overpayments
First Pass Resolution Rate
The percentage of claims that are paid on the first submission without the need for any follow-up, resubmission, or appeal.
Why It Matters
Every claim that requires rework adds cost and delays revenue. Improving first pass resolution directly reduces overhead and accelerates cash flow.
How NEOMed Improves This
- Accurate demographic and insurance data capture at registration
- Pre-authorization verification before services are rendered
- Coding accuracy audits and ongoing coder education
- Payer-specific submission rules built into the claim workflow
- Automated charge reconciliation to catch missing claims
Patient Collection Rate
The percentage of patient-owed balances that are successfully collected, including copays, coinsurance, deductibles, and self-pay amounts.
Why It Matters
With high-deductible health plans on the rise, patient responsibility now accounts for 30%+ of practice revenue. Failing to collect at time of service dramatically reduces recovery rates.
How NEOMed Improves This
- Point-of-service collection strategies and staff training
- Transparent patient cost estimates before treatment
- Automated patient billing with multiple payment channels
- Flexible payment plan options for larger balances
- Timely and clear patient statements with online pay portals
Charge Lag (Days to Bill)
The number of days between the date of service and the date a claim is submitted to the payer. Measures front-end efficiency of the billing process.
Why It Matters
Every day of charge lag delays payment by at least one day. Extended charge lag increases the risk of timely filing denials and compounds A/R days.
How NEOMed Improves This
- Same-day or next-day charge entry after date of service
- Automated charge capture integration with EMR/EHR systems
- Daily encounter reconciliation to identify unbilled services
- Workflow automation to eliminate manual bottlenecks
- Real-time dashboards monitoring charge lag by provider
Denial Overturn Rate
The percentage of denied claims that are successfully overturned through the appeal process, resulting in payment from the payer.
Why It Matters
Many practices accept denials without appealing. With the right expertise and documentation, over 60% of denials can be overturned and recovered.
How NEOMed Improves This
- Structured appeal process with clinical documentation support
- Dedicated denial management team with payer-specific expertise
- Timely appeal filing within payer-required deadlines
- Escalation protocols for complex or high-value denials
- Tracking and reporting on appeal outcomes for process refinement