Staying on top of your RCM performance KPIs is essential to maintaining a healthy healthcare revenue cycle. By tracking critical key performance indicators (KPIs) weekly, healthcare organizations can optimize medical billing, reduce denials, improve cash flow, and ensure their revenue cycle management (RCM) is performing at peak levels.

Let’s explore the most impactful RCM performance KPIs that every clinic or billing department should be reviewing on a weekly basis. Book your free RCM Audit today to understand more.

1. Clean Claims Rate

A strong clean claims rate indicates that claims are being correctly submitted the first time, reducing rework and speeding up payments.

• Why it matters: Clean claims avoid denials and accelerate reimbursement.
• How to measure: Total number of claims submitted without errors / Total claims submitted.

Learn more about submission accuracy on drchrono.com and alpacahealth.io.

2. Claim Denial Rate

This KPI measures the percentage of claims denied by payers. A high denial rate signals issues in documentation, coding, or eligibility verification.

• Industry benchmark: Keep denial rates under 5%.
• Best practice: Analyze denials weekly to catch trends early.

Denial management resources are available on resolvepay.com and esoftskills.com.

3. Days in Accounts Receivable (A/R)

This metric shows the average number of days it takes to collect payment after a claim is submitted.

• Target: Keep under 40 days.
• Why it’s critical: High A/R days slow cash flow and signal inefficiency.

Read about optimizing A/R strategies on cgaa.org.

4. Net Collection Rate (NCR)

The net collection rate (NCR) reflects the percentage of expected revenue collected after adjustments.

• Formula: Payments / (Charges – Contractual Adjustments)
• Goal: 95% or higher.

NCR insights and calculation guides can be found at obiaks.com.

5. Gross Collection Rate

This KPI shows the total percentage of payments collected against gross charges.

• Use this to: Monitor the effect of payer mix and discount structures.
• Tip: Compare gross and net collection rates to spot issues.

Learn more at esoftskills.com and resolvepay.com.

6. Patient Collection Rate

This reflects the percentage of revenue collected directly from patients.

• Why it’s important: With growing patient responsibility, this number impacts total revenue.
• How to improve: Offer multiple payment channels and clear estimates.

Resources on patient payment strategies at alpacahealth.io.

7. Cost to Collect

This KPI measures the expense incurred for every dollar collected.

• Ideal range: Under 5% of total revenue.
• Red flag: Rising costs can erode margins.

Use tools from esoftskills.com to analyze billing efficiency.

While denial rates focus on rejections, tracking the total number of claims submitted each week can help identify inconsistencies in billing activity and detect drops due to workflow gaps or staff performance.

• Why it matters: A sudden decline in claim volume may indicate delayed documentation, EHR issues, or staff shortages.
• Pro tip: Pair this metric with clean claims rate and denial rate for a full picture of your medical billing effectiveness.

Additional insights are available at drchrono.com and alpacahealth.io.

Weekly Monitoring: The Key to Better RCM

Weekly review of your rcm performance kpis enables:

• Faster response to red flags
• Better resource allocation
• Improved team accountability
• Sustainable improvements in the healthcare revenue cycle

Explore more revenue cycle management tools and training at alpacahealth.io and cgaa.org.