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
- 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
- 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.