The first quarter is nearly over, and the question a practice owner asks in the last week of March is some version of "how are we doing?" The usual answer is a deposit total and a feeling. The better answer is a one-page scorecard with the same twelve numbers it showed in February and January, so the owner can see direction as well as level. This piece is the list we use, with the formula, the source and the range that should prompt a question, plus a sample page so you can see what the finished thing looks like.
A word on the ranges. They are the rules of thumb we and most revenue cycle people carry around, drawn from years of MGMA-style benchmarking and audit work. They are not targets for every specialty. A surgical practice with a long global period and a behavioral health practice with heavy Medicaid will sit in different places, and the useful comparison is your own practice month over month.
Key takeaways
- Twelve numbers, one page, the same definitions every month. The trend is the product; a single month's level is only a starting point.
- Half the numbers come from the practice management system and half from the schedule, the clearinghouse and the front desk. A billing vendor alone cannot produce the page.
- Run it on the fifth business day after month end, after remittances have posted, or the denial rate and accounts receivable will lie to you in opposite directions.
- Every number has an owner. The last line on the page is the two or three actions the numbers imply.
The twelve numbers
| # | Metric | Formula | Source | Ask a question when |
|---|---|---|---|---|
| 1 | Charges | Total gross charges posted in the month, by date of service | PM system charge report | Down more than 10% with stable visit volume |
| 2 | Visits | Arrived appointments with a billable visit type | Scheduling report | Charges per visit changes without a fee schedule change |
| 3 | Charge lag | Median days from date of service to claim submission; also the 90th percentile | Claim submission report | Median above 3 days, or 90th percentile above 10 |
| 4 | First-pass acceptance | Claims accepted by the payer on first submission divided by claims submitted | Clearinghouse 277 reports | Below 95% |
| 5 | Denial rate | Denied claim lines divided by adjudicated claim lines, by payer | ERA / remittance analysis | Above 8% overall, or one payer above 12% |
| 6 | Top five denial reasons | Count and dollars by CARC group (eligibility, authorization, coding, timely filing, necessity) | ERA analysis | Same reason in the top five three months running |
| 7 | Net collection rate | Payments divided by (charges minus contractual adjustments), trailing 12 months | PM payments and adjustments | Below 95% |
| 8 | Days in AR | Total AR divided by average daily charges (last 90 days) | AR aging report | Above 40 days, or rising three months in a row |
| 9 | AR over 90 days | AR older than 90 days divided by total AR, insurance and patient separately | AR aging report | Insurance above 15%; patient above 30% |
| 10 | Unbilled encounters | Signed encounters without an accepted claim older than 5 days, plus unsigned encounters older than 3 days | Schedule vs. claims reconciliation | Any number that is not shrinking |
| 11 | Time-of-service collections | Patient payments collected at the visit divided by estimated patient responsibility for those visits | Front desk payment report and eligibility responses | Below 70% |
| 12 | Credit balances and unapplied cash | Sum of patient and payer credits; sum of unapplied payments older than 30 days | Credit balance and suspense reports | Growing, or any unapplied item older than 60 days |
Two definitions deserve a sentence each because they are argued about most. Net collection rate measures how much of the money you were contractually entitled to you actually collected; it strips out the contractual write-off so that a payer mix change does not look like a collections problem. Days in AR converts the total outstanding balance into "how many days of charges are sitting unpaid", which is why a practice with rising charges can see days in AR fall while the dollar balance grows.
How to build it in a week
- Write the definitions down exactly as in the table, and do not change them. Half of all scorecard arguments are about definitions. Net collection rate with and without patient balances are different numbers; pick one and label it.
- Find each report once and record the exact report name and filter settings. A charge report by posting date and a charge report by date of service will not agree. Use date of service everywhere except for cash, which is by deposit date.
- Freeze a cut-off. Run everything on the fifth business day of the following month, after the prior month's remittances have posted. Running it on the first produces a bad denial rate and a good AR every month.
- Put a name next to each number. Charge lag belongs to the providers and the coder. First-pass acceptance belongs to the biller. Time-of-service collections belongs to the front desk lead. AR over 90 belongs to the follow-up person. A number without an owner is decoration.
- Add last month and the same month last year as two more columns. Direction is the point.
What the page looks like
Here is a sample for a fictional four-provider internal medicine practice, February 2025 against January, with the questions the page raised at the monthly meeting.
| Metric | January | February | Owner | Question raised |
|---|---|---|---|---|
| Charges | $412,000 | $388,000 | Practice manager | Two fewer clinic days; charges per visit flat. No action. |
| Visits | 2,140 | 2,015 | Practice manager | Consistent with the calendar. |
| Charge lag (median / 90th) | 2 / 6 days | 4 / 14 days | Providers, coder | One provider's unsigned notes. Named at the meeting. |
| First-pass acceptance | 96.8% | 96.5% | Biller | Fine. |
| Denial rate | 7.1% | 9.8% | Biller | Eligibility denials up. Front desk verification rate fell to 78%. |
| Net collection rate (trailing 12) | 96.2% | 96.0% | Biller | Stable. |
| Days in AR | 38 | 41 | Follow-up lead | Third monthly rise. Split by payer next month. |
| Insurance AR over 90 | 13% | 16% | Follow-up lead | One Medicaid MCO is 40% of it. |
| Time-of-service collections | 72% | 61% | Front desk lead | Deductible season plus a new hire at the desk. |
Three of twelve numbers moved enough to matter, and each pointed at a person and a fix: a signing habit, a verification step, and a payer follow-up project. That is a productive twenty-minute meeting. The same month described as "deposits were down a bit" is not.
Reading it: three patterns
Charges flat, visits flat, charge lag up from 2 days to 7. A provider has stopped signing notes on the day of service. Look at unbilled encounters by provider (number 10) and you will find the name. The fix is a conversation, not a report.
First-pass acceptance 97%, denial rate 11%, top reason eligibility. Claims are clean enough to reach the payer but the coverage is wrong. The front desk is not running eligibility before the visit. Time-of-service collections (number 11) will be low in the same month for the same reason, because the desk did not have a number to ask for.
Net collection rate 96%, days in AR 52, AR over 90 at 24%. The practice is collecting what it is owed eventually, but slowly. Follow-up is happening late, or one large payer is paying slowly. Split number 9 by payer and the answer is usually one name. If it is a payer, the fix is a status project on that payer's aged claims; if it is spread evenly, the follow-up queue is understaffed or badly prioritized.
Mistakes that make scorecards useless
The first is twenty-five metrics instead of twelve; nobody reads page two. The second is changing definitions mid-year so the trend disappears, usually when a new billing manager arrives with a different favorite formula. The third is reporting collections only. Cash tells you what happened two months ago; charge lag and first-pass acceptance tell you what will happen next month, and a scorecard without leading indicators is a bank statement. The fourth is presenting the scorecard without the two or three actions it implies; the last line of the page should be "this month we will". The fifth is letting the billing vendor produce it alone. The vendor cannot see visits or time-of-service collections, and those are where the leaks start, so the practice has to supply half the page.
Questions we hear
Which number matters most?
If we could only see one, it would be first-pass acceptance by payer, because it is the earliest warning. If we could see two, add unbilled encounters. Everything else is a consequence of those two and of how quickly denials are worked.
Can a small practice do this without a data person?
Yes. Every practice management system produces the underlying reports; the work is defining the twelve numbers, finding the reports once and repeating the process on the same day each month. Two hours a month after the first setup, and the first setup is a week of an office manager's spare hours, not a project.
What does Revelrex provide?
Practices using our medical billing service receive a monthly report built on these definitions, and the RCM audit establishes the baseline for all twelve on a 90-day window so the first scorecard has something to compare against. Our practice transformation work uses the same page as the operational half of the picture.
What to do this month
- Copy the twelve definitions into a one-page template with columns for this month, last month and the same month last year.
- Find the report and filter settings for each number once, and write them on the back of the template.
- Set the run date as the fifth business day of April and put it on the calendar as a recurring task.
- Assign an owner to each number and tell them before the first meeting, not at it.
- Run March as the first month, even if some numbers are rough, and write the two or three actions at the bottom.
- Book a twenty-minute review with the owners and the practice owner for the second week of April.
