Q&A: Key performance indicators for payer scorecards

April 15, 2019
Medicare Web

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.