Q&A: Key performance indicators for payer scorecards

Q: What are the recommended key performance indicators (KPI) to include on a payer scorecard?

A: A typical payer scorecard contains many KPIs that are standard across the
industry. These include the following:

• Days in A/R
  • Overall
  • By product
• Aging of A/R
  • Break out the aging buckets
• Percentage of payment variance compared to revenue
• First-pass resolution of claims
  • Denial rate
  • Initial
  • Final
• Dollars denied
• Appeal aging
• Late payments
• Underpayments as a percentage of cases
• Underpayments as a percentage of net revenue
• Percentage of bad debt
• Payer percentage of the facility's revenue
• Utilization by payer product line
• Cost to collect

Some accounts receivable systems include dashboards or payer performance metrics; however, if you use these canned
metrics, you must test the data manually to validate accuracy.

For more information see The Essential Guide to Healthcare Payer Contracting.