Medical billing and coding are always considered complex and time taking tasks. In reality, it’s the coding aspect that can turn down some practitioners.

Therefore, planning some KPIs of medical coding for your billing cycle can be beneficial. Also, you should focus on healthcare KPIs (Key performance indicators).

These factors can really help you determine the areas of your billing cycle that are lacking. So, let us find out what are the key performance indicators for medical coding & billing.

1: Account Receivable Days

Account Receivables or simply AR is an important aspect of your medical billing revenue cycle. Therefore, it is essential to include it in your health care KPIs. Here the rule is simple, the shorter the number, the better it gets.

There could be several reasons that explain why your billing cycle has increased AR days. One reason could be that some insurance companies might be releasing the payment late.

So, to minimize your account receivable days, you should list down the possible factors that slow your billing cycle. Simply work on them to ensure that you get paid on time.

2: Gross Collection Rate

Improving productivity is the key aspect for running your practice & GCR is the key factor in that. The Gross Collection Rate (GCR) is also among the important key performance indicators for medical coding & billing.

This metric measures the percentage of total invoiced charges that are collected by the provider. The GCR is important because it provides insight into the overall effectiveness of the provider’s billing and collections process.

There are a number of factors that can impact the GCR, including the type of services provided, payer mix, and demographics of the patient population. In general, providers with a higher GCR tend to be more efficient in their billing and collections process, which can lead to improved cash flow and overall financial health.

How to Calculate

To calculate this KPI of medical coding & billing, divide the total amount of money collected by the total amount of money billed.

3: The Influence of Denial Rate 

The denial rate is a key performance indicator (KPI) for billing that measures the percentage of claims denied by payers. Denials can occur for a variety of reasons, including incorrect coding, missing documentation, or errors in the claim submission process.

A high denial rate can have a significant impact on a provider’s bottom line, so it is important to track this KPI and work to reduce denials whenever possible.

There are a few different ways to calculate the denial rate KPI. One common method is to take the total number of denials divided by the total number of claims submitted. This can be expressed as a percentage or as a ratio.

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4: Percentage of Unbilled Claims 

The percentage of unbilled claims KPI measures the percentage of claims that have not been invoiced to insurance companies. A high percentage indicates inefficiencies in the billing process.

This KPI is important to track because it can reveal issues with your billing process. A high percentage of unbilled claims could mean that you’re not submitting claims in a timely manner, or that you’re not correctly coding the claims. This can lead to decreased revenue and profits for your practice.

How to Calculate?

To calculate this KPI, simply divide the number of unbilled claims by the total number of claims. This will give you the percentage of unbilled claims.

5: Net Collection Rated to the gross collection, the net collection does not include any additional charges such as taxes. So, this revenue cycle metric is also considered one essential KPI of any billing cycle.

As a practitioner, you have to find out whether your net collection rate is in good range or not. Is it too low or just satisfactory? Either case, you should find out the possible causes that are affecting your net collection rate.

Your net collection rate basically indicates how successful your practice has been in collecting the amount owed. Compare

How to Calculate

Simply divide the amount that is owed to the insurance companies and patients by the amount you actually receive from them.

Bottom Line

To sum things up, KPIs of medical coding & billing can’t be ignored. If you really want to claim the best against your practice, working on these key performance indicators is a must. At some point, you may need help from a medical billing expert.