What KPIs Reveal About Your Medical Billing Company

In todays competitive healthcare landscape, the financial health of a medical practice hinges on the performance of its billing operations. As medical billing becomes more complex and compliance-driven, many healthcare providers turn to third-party companies for help. But how do you know if your medical billing company is actually doing a good job?

The answer lies in Key Performance Indicators (KPIs).

KPIs provide measurable insights into how effectively your revenue cycle is being managed. They reveal whether claims are being processed accurately, payments are being collected in a timely manner, and denials are being resolved efficiently. Simply put, KPIs shine a light on the strengthsand weaknessesof your billing partner.

At Thrive Medical Billing, we prioritize transparency, and we believe our clients should have complete visibility into the performance of their billing operations. In this article, well explore the most critical KPIs you should monitor, what they reveal about your medical billing company, and how to use these metrics to optimize revenue and practice performance.

Why KPIs Matter in Medical Billing

A professional medical billing company is responsible for much more than just submitting claims. It oversees the entire revenue cycle, from coding and documentation to payment posting and patient collections. Monitoring KPIs allows you to:

• Evaluate your billing companys performance

• Spot inefficiencies and revenue leaks

• Make informed financial decisions

• Ensure compliance with insurance and regulatory requirements

• Improve cash flow and profitability

Ignoring these metrics can leave your practice in the darkrisking underpayments, slow reimbursements, or even compliance violations.

Top KPIs to Monitor With Your Medical Billing Company

1. First-Pass Resolution Rate (FPRR)

What It Is:
The percentage of claims that are successfully submitted and paid without any rework or denial.

Why It Matters:
A high FPRR (ideally over 90%) indicates that your medical billing company is submitting clean claims with accurate codes and complete documentation.

What It Reveals:
A low FPRR may point to coding errors, incomplete patient data, or misalignment with payer requirements. It could also suggest that your billing company lacks specialty-specific knowledge.

How Thrive Medical Billing Excels:
We leverage certified coders, automation tools, and robust audits to ensure high claim acceptance rates from the very first submission.

2. Days in Accounts Receivable (A/R)

What It Is:
The average number of days it takes for your practice to collect payments after a service is rendered.

Why It Matters:
Shorter A/R cycles mean faster cash flow and better financial stability. A benchmark of 3040 days is considered ideal.

What It Reveals:
High A/R days (over 60) suggest poor follow-up, claim delays, or ineffective patient collections. It could mean your medical billing company is not following up on unpaid claims or underperforming on appeals.

How Thrive Medical Billing Excels:
We proactively monitor and pursue outstanding A/R using automated reminders and dedicated follow-up teams, helping clients get paid faster.

3. Claim Denial Rate

What It Is:
The percentage of claims denied by payers compared to the total number submitted.

Why It Matters:
A denial rate under 5% is the industry goal. Anything higher signals inefficiencies or preventable errors.

What It Reveals:
High denial rates can indicate problems in documentation, coding, eligibility verification, or lack of compliance with payer guidelines.

How Thrive Medical Billing Excels:
Our team tracks denial trends, identifies root causes, and works closely with providers to fix issues at the sourcedramatically reducing future denials.

4. Net Collection Rate (NCR)

What It Is:
The percentage of allowed charges your practice actually collects after contractual adjustments and write-offs.

Why It Matters:
An NCR above 95% shows that your medical billing company is maximizing collections and minimizing revenue loss.

What It Reveals:
A low NCR can reveal uncollected balances, underbilling, or excessive write-offsoften stemming from ineffective billing processes.

How Thrive Medical Billing Excels:
We provide detailed reporting and aggressive follow-up strategies that ensure providers collect as close to 100% of their entitled reimbursements as possible.

5. Charge Lag Days

What It Is:
The time between the date of service and when the claim is submitted to the payer.

Why It Matters:
Short charge lag times (within 24-48 hours) indicate efficient workflows and faster revenue cycles.

What It Reveals:
Delays in charge submission can slow down your entire billing process, leading to aging A/R and delayed cash flow.

How Thrive Medical Billing Excels:
We use automated systems to submit charges quickly, reducing lag time and ensuring claims get to payers as soon as possible.

6. Patient Collection Rate

What It Is:
The percentage of patient responsibility (co-pays, deductibles, balances) successfully collected.

Why It Matters:
With high-deductible health plans on the rise, collecting from patients is now more important than ever.

What It Reveals:
A low patient collection rate might reflect poor communication, confusing statements, or inadequate payment options.

How Thrive Medical Billing Excels:
We offer user-friendly patient billing statements, multilingual support, and multiple payment methods to maximize patient collections and satisfaction.

7. Clean Claim Rate

What It Is:
The percentage of claims that are submitted without any errors.

Why It Matters:
Clean claims lead to quicker reimbursements and fewer denials. The industry benchmark is typically 95% or higher.

What It Reveals:
If your clean claim rate is low, your medical billing company may lack proper quality control or coding accuracy.

How Thrive Medical Billing Excels:
We maintain a strict internal review process, use claim scrubbers, and provide ongoing coder education to ensure clean claims every time.

How to Use KPIs to Hold Your Billing Company Accountable

Its not enough to simply track KPIsyou must also use them to evaluate and improve your relationship with your medical billing company. Here's how:

• Set benchmarks: Define acceptable performance standards for each KPI

• Review reports regularly: Insist on monthly or real-time reporting from your billing partner

• Request explanations: If a metric drops, your billing company should explain why and propose a fix

• Align goals: Make sure your billing partner understands your financial and operational goals

• Take action when needed: If performance doesnt improve, it may be time to consider a more capable company like Thrive Medical Billing

Why Providers Trust Thrive Medical Billing

At Thrive Medical Billing, we dont hide behind vague reports or generic metrics. We provide full transparency through customized dashboards and reports, giving you a complete view of your financial performance.

Heres what sets us apart:

• Real-time KPI tracking through secure portals

• Certified billing and coding experts for error-free submissions

• Automated systems that speed up charge entry, claim submission, and follow-ups

• Personalized support and account management

• Proactive denial management and appeals

• Specialized teams for various medical specialties

Whether youre a solo provider or a multi-location practice, we provide the visibility and reliability you need to grow confidently.

Final Thoughts

KPIs are the heartbeat of your revenue cycle. They dont just show how your billing is performingthey reveal whether your medical billing company is truly supporting your success.

If youre not getting clear answers or actionable insights from your current billing provider, it may be time to switch to a partner that values data transparency, accountability, and excellence.

Thrive Medical Billing is built around results. Our data-driven approach and commitment to best practices ensure your KPIs stay strong, your cash flow remains steady, and your practice continues to thrive.