By Lemuel Areglo, CPC | Director of Revenue Cycle Management Services
Key Takeaways
- Many cardiology practices face visibility challenges rather than outright billing crises. If your cash flow is inconsistent, the first step is identifying which performance metrics are lagging and by how much.
- Denial rates exceeding 10% are unacceptable. High-performing cardiology practices maintain rates below 5% by combining proactive measures with efficient appeals when denials occur.
- Claims should be submitted within 24 hours of patient encounters. Each day a claim remains unsubmitted adds to the payment timeline, affecting overall revenue.
- Monitoring relevant KPIs is essential for assessing the performance and efficiency of your billing operations.
If you’re closely monitoring your revenue cycle but still experiencing slow cash inflow, the issue often lies in visibility rather than effort. Most cardiology practices do not have a billing crisis; they have a measurement gap.
Here are nine key performance indicators (KPIs) that can significantly enhance your billing services, along with benchmarks and actionable insights for improvement.
Table of Contents
How We Selected These Nine
Not every billing metric warrants your attention. We focused on those directly linked to revenue, controllable by billing services, and applicable to cardiology practices. If it doesn’t impact cash flow, staff workload, or compliance, it was excluded from our list.
1. Days in Accounts Receivable
This metric indicates how long it takes to convert a patient visit into cash. High-performing cardiology practices aim to keep this under 30 days. If your days in accounts receivable exceed 50, there may be issues with claim submission speed or follow-up on aging accounts.
The solution is straightforward: ensure same-day claim submission, verify insurance eligibility prior to appointments, and actively monitor accounts that are 61–90 days old.
2. Clean Claim Rate
Every claim that is denied costs time and delays payment by days or even weeks. The industry standard for clean claims is 95%+, with top billing operations achieving 98%.
The difference often lies in pre-submission scrubbing, which includes identifying missing modifiers, invalid codes, and payer-specific requirements before claims are submitted. This foundational work is essential for ensuring a steady cash flow.
3. Denial Rate
Currently, denial rates in the industry range from 12% to 15%. High-performing practices maintain rates below 5%. This discrepancy represents a significant amount of revenue that practices either recover slowly or write off entirely.
Billing services address this through two main strategies: prevention (eligibility checks, prior authorization tracking, accurate coding) and recovery (appeals, pattern analysis, and addressing root causes to prevent recurring denials). Both strategies are crucial, yet many practices focus on only one.
4. Net Collection Rate
This metric reveals the percentage of the revenue you are actually collecting. A rate below 90% indicates that you are missing out on revenue due to underpayments, unbilled charges, or unresolved denials.
Aim for a net collection rate of 95% or higher. Achieving this requires conducting charge capture audits, implementing automated underpayment detection, and diligently following up on accounts until they are fully paid.
5. First-Pass Resolution Rate
This metric assesses the efficiency of your billing process by measuring how often claims are paid correctly on the first submission—without rejections, underpayments, or appeals. A low rate indicates that your billing staff is spending too much time resolving issues instead of processing new claims.
Strive for a first-pass resolution rate of 95% or higher. Improving this metric often uncovers specific failure points that, once addressed, can enhance overall billing performance.
6. Charge Capture Rate
This metric represents preventable revenue loss. You provided the service, documented it, but failed to bill for it.
Missed charges often occur in ancillary services, supplies, and procedures that were documented but not coded. A billing service can help close this gap by reconciling clinical notes against submitted charges and flagging any discrepancies before filing deadlines.
7. Patient Collection Rate
Patients are increasingly responsible for a larger portion of their healthcare expenses, with industry averages for collection rates on these balances ranging from 34% to 48%. This is not merely a billing issue; it is fundamentally a communication challenge.
Clear and understandable billing statements, accessible payment plan options, and proactive outreach before balances age into bad debt are essential. While these strategies are not groundbreaking, many practices lack the systems to implement them consistently.
8. Claims Submission Speed
Medicare has a 14-day payment floor. Each day a claim remains unsubmitted extends your payment timeline. Claims should be submitted within 24 hours of an encounter—this is non-negotiable.
The bottleneck often occurs at the transition between clinical documentation and billing. When these systems are integrated, delays are minimized. If they are not, manual data transfers can lead to errors and missed submissions.
9. Cost to Collect
This metric is frequently overlooked. If you are spending 10 cents to collect every dollar, it significantly impacts your operating margin, a detail that can be easily missed in monthly reports. The target should be under 5%.
Outsourcing billing does not automatically reduce this cost; however, a competent billing service can help lower it by distributing technology and staffing expenses across a broader client base than any single practice can afford.
A Quick Reference Guide
KPI
Target
Primary Lever
Days in A/R
<30 days
Faster submission + follow-up
Clean Claim Rate
≥95%
Pre-submission scrubbing
Denial Rate
<5%
Prevention + appeals
Net Collection Rate
≥95%
Persistent A/R work
First-Pass Resolution
≥95%
End-to-end tracking
Charge Capture Rate
≥98%
Documentation audits
Patient Collection Rate
>50%
Clear statements + payment plans
Claims Submission Speed
<24 hours
Same-day processing
Cost to Collect
<5%
Process efficiency
Where to Start
Focus on one or two metrics at a time rather than attempting to address all nine simultaneously. Identify the areas where you are furthest from benchmarks—this will provide the quickest route to recovering lost revenue. If your denial rate exceeds 10%, that should be your priority. If claims are sitting for several days before submission, that’s where to start.
A reputable billing service will establish baseline metrics before promising results and will provide regular updates thereafter. If they cannot inform you of your denial rate, that is a significant concern.
Cardiology Billing Services integrates seamlessly with clinical documentation, which is crucial for improving metrics such as clean claim rates and submission speed. This integration eliminates data re-entry and manual handoffs. When the provider completes the encounter, billing begins automatically. Such structural improvements lead to sustainable enhancements in performance—not just temporary fixes.
Curious about your clinic’s performance? Establishing a baseline RCM assessment is the first step.
Lemuel Areglo, CPC
is the Director of Revenue Cycle Management Services at WRS Health, bringing nearly 15 years of experience leading medical billing, coding, credentialing, and revenue cycle operations across the healthcare industry. Lemuel’s expertise spans the full revenue cycle, including claims management, denial resolution, payment posting, accounts receivable, and practice operations. He has extensive experience supporting various specialties, including cardiology, psychiatry, physical therapy, pain management, internal medicine, orthopedic surgery, speech therapy, and sleep medicine.
