Medical Billing & Revenue Cycle Metrics: Claims, Denials & Days in AR

What you'll build

What you will be able to do

Each lab ends with a concrete result that you build yourself and the checker confirms, cell by cell.

• Split ten remittance lines into contractual adjustment and patient responsibility, then measure how much of the fee schedule each payer actually allows.
• Measure how many claims get through the edits untouched and how many are paid on the first submission, month by month and for the half year, and count the months that meet both targets.
• Count one week's 30 denials by reason, build the cumulative share for a Pareto analysis, calculate each payer's denial rate and draw the Pareto chart.
• Age every open claim from its date of service, sort it into aging buckets with an approximate lookup, and calculate the share of A/R over 90 days and the days in A/R.
• Calculate the net collection rate per payer and in total, keep controllable write-offs where they belong, size the dollars missing to the target and name the weakest payer.
• Split the allowed amount of eight claims into copay, deductible and coinsurance, total what the patients owe and measure how much of it the front desk collected at the visit.
• Add up what the billing office costs each quarter, turn it into the cost to collect per dollar of cash, and measure how much revenue is lost to administrative and bad-debt write-offs.
• Turn eight revenue-cycle KPIs into an on/off-target status that respects whether higher or lower is better, measure the gap to each target, score the dashboard and flag the misses in red.