Optimization is a must


1. Accounts Receivable

This measure reveals how quickly a practice turns receivables into cash. Ideally, organizations should be keeping this metric under 30 days to yield nimble cash flow.

  • Are you following up on your denied claims?
  • What about claims that never receive a response?
  • Are you loosing money to timely filing?
  • Who stays current with your billing when your staff is on vacation or out sick?


2. Age of Receivables

This number shows how long a receivable has been outstanding. The longer a claim remains unpaid, the less likely it will be collectible. Organizations should examine those receivables past due over 90 days and determine whether there are preventable issues that can be addressed to shorten the payment time frame and prevent similar problems in the future.

  • What is your percentage of A/R over 90 days?
  • How often do you review this report?
  • How much money are you loosing by submitting claims that are months old?
  • Does your staff care about increasing your revenue?

3. Average Daily Charges

Practices should track this metric over time to identify any patterns which could reveal productivity issues or patient volume fluctuations. For example, by monitoring this measure a practice can pinpoint staff members who are under performing and provide further training. Similarly, this measure can highlight seasonal patient volume variations that may represent opportunities to temporarily augment staff to better manage cash flow.

  • Does your staff know how to analyze this data or do they even have time?
  • Do you have a certified coder reviewing your claims?
  • Do you have large swings in total collections from month to month?
  • Are you billing out everything you should be?

4. Collections Percentage

This statistic compares the payments a practice receives with what it is supposed to receive for the services it provides. Using this measure shows how well the practice optimizes payer contracts and collects balances due from patients.

  • Are your payers contracts out of date and costing you money?
  • What are other Physicians making providing the same service?
  • What technologies are other practices using to increase Collection Percentage?
  • Does it feel like you are working harder and seeing more patients to make the same amount?

5. Clean Claim Rate

Using technology, this number should be high (near 100%) as claims scrubbers and other tools identify “dirty claims” prior to claims submission, allowing the organization to fix them before sending the claim to the payer. A decline may indicate the need to change payment rules and algorithms, improve workflows or train staff.


  • CPS has a 99% first time submission rate.
  • Does your EMR allow you to create rule engines specific to your needs?
  • What percentage of your denied claims end up getting lost to timely filing?
  • Is your team receiving feedback to prevent denied claims in the future?

6. Patient Collections

With the advent of high- deductible health plans, patients are taking on greater payment responsibility. Whereas providers used to be haphazard in collecting co payments, deductibles, and coinsurance, there is increasing pressure to fine-tune this process  to prevent large revenue shortfalls. Practices that watch patient collection rates can make sure their front line staff are asking for and collecting payments consistently and reliably. Outliers in this area can point to the need for staff training, patient education and standardized processes for soliciting payment.


  • Are you reaching your patients on every platform you can (Statements, messaging, mobile apps)?
  • Is your staff taking the time to collect demographics and insurance information correctly?
  • CPS provides a full Patient Collections Solutions.
  • When is the last time you reviewed a Write Off Report?

7. Denials

Practices should keep a close eye on rejections and denials, because they can highlight a wide array of problems, ranging from staff errors to payer rule changes to lack of eligible verification. Practices that watch for denial trends can catch systemic issues and prevent future rejections.

  • Denials should be extremely rare if you are using rule engines and scrubbing claims.  <1%
  • If a claim is being denied are you translating that information to the team?
  • Are claims being approved that should have been denied and will result in a refund?
  • How many denied claims are a result of the constant turn over in your staff?