Four KPIs to review monthly
- Clean claim rate: share of claims accepted on first submission without edits or rework
- Denial rate: share of claims denied by payers, tracked by reason
- Days in A/R: average time to collect payment
- Net collection rate: payments collected as a share of what you were allowed to collect
Reading the trends
A falling clean claim rate usually points to front-end or coding edits. Rising denials for one payer often signal a policy change. Growing days in A/R can mean claims are stalled in follow-up. Look at trends by payer and provider, not just the totals.
Watch your filing limits
Every payer sets a timely-filing limit, and some are short. Some state Medicaid programs, for example, allow as little as 90 days from the date of service. Check each payer's current provider manual and build reminders into your workflow.
Frequently Asked Questions
What is a good clean claim rate?
Many practices aim for 95% or higher on first submission.