Outsourcing your medical billing means you have certain expectations. You expect your partner to deliver timely revenue, low denials, and transparent reporting, to start with. However, many practices discover hidden gaps only after cash flow stalls or A/R balloons.
Knowing the top KPIs your billing partner should be tracking—but probably isn’t—can help you spot underperformance early, hold vendors accountable, and boost your practice’s profitability. That’s why this post is going to look at why these critical metrics matter, highlight the most overlooked KPIs in healthcare billing, and show how AMS Solutions monitors and optimizes each one to exceed industry standards.
What Makes a Great Billing Partner
An exceptional medical billing partner goes beyond submitting claims. We focus on data‑driven processes and best‑in‑class technology that drive results in real time. Key qualities include: expertise in specialty‑specific coding, continuous staff training on evolving payer rules, and a relentless pursuit of every dollar owed. With over 30 years of experience serving practices nationwide, we combine personal relationships and transparent fee structures to deliver a net collection percentage that consistently exceeds the national average.
Top KPIs Your Billing Partner Should Be Tracking (But Probably Isn’t)
- Clean Claim Rate: The percentage of claims accepted on the first submission. A low clean claim rate signals coding errors or mismatches with payer requirements, costing you time and money.
- First Pass Resolution Rate: Measures the percent of denials that are overturned with a single appeal. This KPI shows how effectively your partner handles routine payer pushback.
- Overall Denial Rate: Tracks all claims denied divided by total claims submitted. Industry averages hover around 5 percent; anything above 3 percent warrants deeper analysis.
- Days in Accounts Receivable (A/R): The average number of days between service and payment receipt. Keeping this under 35 days maintains healthy cash flow and reduces bad debt risk.
- Net Collection Rate: Actual payments received divided by total allowed charges. A rate above 95 percent indicates top‑tier performance, while anything under 90 percent suggests write‑offs or missed collections.
- Aged A/R Over 90 Days: The dollar amount of outstanding receivables older than 90 days. High levels here point to unaddressed denials or follow‑up failures that must be corrected.
Generally speaking, consistently monitoring these medical billing KPIs and revenue cycle metrics gives you clear insight into your partner’s efficiency, accuracy, and commitment to your bottom line.
How AMS Solutions Monitors & Reports Your KPIs
At AMS, we implement automated dashboards that update daily with each KPI. Data from your claims management system, electronic health records, and payer remittance reports feed into our secure client portal so you can access real‑time metrics any time.
Our data analysts review exceptions continuously, flagging trends such as rising denial rates, lengthening A/R days, or unexpected shifts in payer mix. We also configure customized alert thresholds so your practice manager receives instant notifications whenever a critical metric deviates from the target range.
Each month, we compile comprehensive performance reports complete with detailed commentary and visual charts. These reports benchmark your practice against national standards and specialty‑specific norms, providing context for every data point.
If any KPI falls below the agreed threshold, we initiate a root cause analysis and corrective action plan. Depending on the underlying issue, this may include retraining coding staff, refining payer rule sets, accelerating appeals, or deploying new software automation.
Our proactive, data‑driven approach ensures continuous optimization of your revenue cycle so your practice maintains peak financial performance.
Take a Proactive Step Toward Optimal Revenue Cycle Management with AMS
Overlooked KPIs can compromise your practice’s financial health. Partner with us to streamline and optimize your revenue cycle performance. Contact AMS Solutions today for a free practice audit and learn how we track every critical metric to maximize your collections and minimize write‑offs.