Medical Billing Benchmarks | Healthcare RCM and AR Metrics

Claimocity Benchmarks

Performance that Matters

Over 40 years of award-winning billing and coding experience.

A brief look at how the Claimocity software stacks up in relevant revenue cycle categories for billing and coding efficiency, and how our array of claim collecting and processing benchmarks and percentiles measure up against the best in the industry.

“We started out with just the charge capture software but had over 200 thousand in outstanding collections that we couldn’t get clear answers about from our billers. Got so bad we made a change. Claimocity did a full audit and saved everything that was still viable, about 64%. Over a third lost. Was upsetting to say the least until we started collecting 18% higher revenue per month as a practice after the switch. Morale of the story is don’t keep feeding good claims into a broken process.”

-Rose Jusayan, M.D | Nephrology Hospitalist | Nevada

What Revenue Cycle Management Services Do You Offer?

Claimocity is both a software and a service but the backbone of the software is empowered by the absolutely stunning revenue cycle results we are able to generate.

Our clean claim rate is remarkable, our collection stats are through the roof and our team is able to take those challenging claims that other companies write off and finesse, maneuver, or brute force them through the process.

Our goal is to get every claim processed and paid and we are the best int he business at getting this done. We not only have the top tier talent in the business but we have the numerical advantages, enabling us to work in groups around the clock to run claims through rigorous quality control and process them within the first hour, often within the first five minutes.

Our account managers follow providers through their busy workdays, proactively identifying and resolving issues, sending reminders, making corrections, and running everything through our AI to double, triple, and quadruple check for any issues that could prevent a clean slide through to a faster reimbursement.

What Benefits Do the Billing Software and Services Have Together?

There simply is no substitute for the intelligence and analysis that comes from having control of the entire revenue cycle from the point of care to the final reimbursement.

Stand alone charge capture services do a relatively good job of capturing charges, but the fluidity of the move from one software to another or into a separate service leaves gaps where charges inevitably get stuck or lost. These stuck points, along with other holes and inefficiencies go unrecognized because the initial software has seemingly done it’s job and the doctor does not have the time, let alone billing expertise, to recognize the subtle differences between numerical totals of claims going in and payments coming out.

The billing team on the other end of the charge capture should theoretically be catching this but without tracking the process on the charge capture side they more often than not miss 3-5 charges (roughly equivalent to $400-$500) per provider per month in just this one gap alone.

Start stacking those gaps and multiplying by the number of providers in the practice and you can see how these simple transitional revenue inefficiencies from charge capture software to in-house or outsourced billing services can quickly turn into tens to hundreds of thousands of dollars in avoidable losses from this one area alone.

Is Claimocity a Traditional Billing Company?

There is nothing traditional about us. But in terms of services provides, we do everything a traditional billing company can do plus more.

Our RCM services can be with or without our software offerings, and we have hundreds of clients that use our billing services alone including surgery centers, skilled nursing facilities, acute care and step down centers, and a wide variety of specialties including hospitalists, physiatrists, hospital psychiatrists, cardiologists, anesthesiologists, urologists, nephrologists, and dozens more.

We offer full practice management, a state of the art 9th gen mobile workflow and billing app for providers, a cloud based portal for seamless transitions across users and platforms, and the full array of productivity tools, EHR/EMR integrations, revenue cycle enhancers, and custom solutions to fit your needs.

Revenue Realization at 45

Claimocity: 95% (#1)

Percentage comparing the average number of claims paid within 45 days to the total number of claims.

Industry Average: 75%

Net Collection Rate

Claimocity: 99.3% (Tied #1)

Percentage of payments received against the maximum possible that could have been collected.

Industry Average: 89.5%

Clean Claim Rate

Claimocity: 99.4% (#2)

Percentage of claims reimbursed upon first submission without error, rejection, or manual intervention.

Industry Average: 95%

A/R % > 60 Days

Claimocity: 5% (#1)

Percentage of submitted claims that remain unpaid in accounts receivable after sixty days.

Industry Average: 20.2%

Days in A/R

Claimocity: 29.1 (Tied #2)

The average number of days that it takes to generate a claim payment.

Industry Average: 45 Days

A/R % > 120 Days

Claimocity: 3.7% (#1)

Percent of submitted claims that remain unpaid in A/R after 120 days.

Industry Average: 15.6%

Claim Denial Rate

Claimocity: 4.2% (#2)

The percentage of submitted claims fairly or unfairly denied by payers.

Industry Average: 9.8%

First Pass Yield Rate

Claimocity: 95.8% (#1)

Percent of submitted claims that are paid upon their first submission.

Industry Average: 82%

Read more about the key RCM metrics descriptions and value on the medical revenue cycle management page…

30-50k

Average Revenue Spike
From Initial A/R Audit

11-38%

Average Annual Revenue
Increase
Per Provider

5-15 Hours

Average Weekly Time
Savingsper Provider

“Our executive team approved participation in a voluntary two year time and revenue study in order to evaluate the quantitative and qualitative value compared to the numbers we were generating with the prior software in order to justify the switch. Within 24 months we had a 41.6% net revenue rate increase as well as an average of 38.8 hour savings per month per physician across our practice, which was a remarkable result.”

Dr. Anas Kayal, Hospitalist Group

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Clean Claim Rate Benchmark

What is a clean claim rate? Commonly referred to as CCR or the revenue cycle “clean claim rate,” the clean claim is a key performance metric that indicates the quality of claim processing and claim-related data being collected and reported. It is a critical measurement benchmark for billing and indicates how many claims out of the total number possible go from processed to paid without intervention. As defined by the HFMA, the clean claim rate is the percentage that comes from dividing the number of claims that pass all edits without manual intervention by the total number of claims accepted into the claim processing billing flow.

This key metric is one of the main indicators of the quality of the billing providers a physician is using. It indicates the experience of the billing experts, the level of proactive error identification and resolution, and the amount of labor that is going to have to be expended to generate a payment.

A higher CCR means fewer labor expenditures, lower days in accounts receivable, quicker payments, and lower associated cost to collect or cost to bill metrics. As a benchmark, the clean claim rate is one of the best metrics of bottom line billing data quality and organizational billing expertise.

Revenue Cycle Performance Benchmarks

With value-based reimbursement and healthcare quality measurements having such a significant impact on decision making, healthcare provider organizations like hospitalist practice groups and hospital administrations are under immense pressure to ensure that their revenue cycle is operating at the highest levels of efficiency.

To effectively evaluate all the critical aspects of the revenue generation happening from the point of care through the claims processing and billing payment cycle, organizations need to develop everything from standard operating procedures built on best practices to revenue performance indicators, KPIs that provide practice leaders with a strategic overview of the organizational operations and providing performance values that can be compared and assessed.

Healthcare Performance Metrics

KPIs such as the HFMAs MAP (measure, apply, and performance) keys allow hospital and practice managers to compare financials and revenue statistics against their immediate peers as well as those on a state and national level by specialty. Beyond just a clean claim rate, net days in AR is a revenue KPI that is critical for evaluating performance, as are the claim denial management statistics.