7 Revenue Cycle KPIs Every Medical Practice Should Track

Revenue cycle management (RCM) covers every step from scheduling to the final payment. A few key performance indicators (KPIs) tell you quickly whether that cycle is working. Review them every month.

1. Clean claim rate

The share of claims accepted and processed on the first submission without edits or corrections. Many practices target 95% or higher. A low rate points to registration, coding or scrubbing problems.

2. Initial denial rate

The percentage of claims denied on first processing. A common goal is below 5–10%. Track the reasons behind it, not just the number.

3. Days in A/R

How many days, on average, it takes to collect payment. Calculate it as total A/R divided by average daily charges. Many well-run practices stay under 30–40 days.

4. A/R over 90 days

The percentage of your receivables older than 90 days. The older a claim gets, the less likely it is to be paid – aim to keep this well under 15–20%.

5. Net collection rate

How much of the money you are allowed to collect (after contractual adjustments) you actually collect. A healthy net collection rate is typically 95% or higher.

6. First-pass resolution rate

The percentage of claims paid in full on the first submission. It combines registration, coding and payer accuracy into one number.

7. Patient collections

With high-deductible plans, patients pay a larger share. Track how much is collected at the time of service and how quickly statements are paid.

Turning KPIs into action

• Compare each KPI month over month and by payer
• Look for the cause behind every change – a new payer rule, a staffing gap, a coding update
• Set targets and review them with your billing team or partner