Overview
CareStack provides Key Performance Indicators (KPIs) and operational metrics to help practices measure financial health, monitor revenue cycle performance, identify workflow inefficiencies, improve collections, reduce claim denials, and optimize overall practice profitability through real-time reporting, dashboards, and analytics.
Insurance AR Days
Purpose
To monitor and improve the efficiency of insurance claim processing, payment posting, and claim resolution workflows within CareStack.
This KPI helps identify:
Delays in claim submission
Outstanding insurance balances
Rejected or unresolved claims
Workflows impacting payment posting
Maintaining low Insurance AR Days supports healthier cash flow, faster reimbursements, and improved revenue cycle management.
Definition
The average number of days it takes for insurance claims to be paid after initial submission.
Recommended Goal - 25 Days or below
Lower Insurance AR Days generally indicate:
Claims are being submitted promptly
Attachments are uploaded timely
Rejections are worked quickly
Payments are posted daily
Claims are being closed correctly
Higher Insurance AR Days may indicate:
Claims sitting in Pending Submission
Missing attachments
Delayed payment posting
Rejected claims not being corrected
Open claims not being finalized
Day Sales Outstanding (DSO)
Purpose
Day Sales Outstanding (DSO) measures the average number of days it takes a practice to collect payment for services rendered, including both patient and insurance receivables.
This KPI helps practices:
Improve cash flow
Reduce Accounts Receivable aging
Monitor patient and insurance collections
Identify opportunities to improve and streamline revenue cycle processes
Helps practices evaluate cash flow performance and identify areas causing delays in collections.
Definition
The average number of days it takes to collect payment for services rendered, including both patient and insurance receivables. This metric reflects the overall efficiency of your practice’s billing and collection processes.
Recommended Goal - 40 Days or less
Lower DSO generally indicates:
Faster collections
Strong insurance workflows
Effective patient collection processes
Timely payment posting
Healthy cash flow
Higher DSO may indicate:
Outstanding insurance claims
High patient balances
Delayed claim submission
Poor upfront collections
Delayed payment posting
Aging Accounts Receivable
Unapplied Insurance Credits
Purpose
Unapplied Insurance Credits measures the amount of unapplied credits remaining from insurance receipts within CareStack. These balances represent insurance payments that have been received but have not yet been fully allocated to claims.
This KPI helps practices:
Reduce outstanding insurance aging
Ensure timely Insurance payment posting
Unapplied Insurance Collections Definition
Total amount of unapplied credits from insurance receipts.
Recommended Goal - 2% or below average monthly insurance production
Insurance Collection Rate by Transaction
Date (TXN)
Purpose
This KPI helps practices evaluate how effectively insurance balances are being collected and how efficiently insurance revenue is being converted into actual payments. Monitoring Insurance Collection Rate provides insight into the health of insurance workflows, claim follow-up processes, and overall Revenue Cycle Management performance.
This KPI helps practices:
Improve insurance reimbursement efficiency
Monitor insurance collections performance
Identify opportunities to streamline insurance workflows
Improve overall cash flow
Definition
Percentage of net insurance collections relative to net insurance production, based on transaction date.
Recommended Goal - 95% or higher
Formula: (Net Insurance Collection (TXN) ÷ Net Insurance Production (TXN)) × 100 “I produced $1000 worth of Insurance Production, and I collected $800 worth of insurance monies within X date range. Therefore I have an 80% Insurance Collection Rate for X date range.” |
Clean Claim Rate
Purpose
This KPI reflects the accuracy and efficiency of the practice’s insurance billing workflows and is one of the most important indicators of a healthy Revenue Cycle Management process.
This KPI helps practices:
Reduce claim denials and rejections
Improve reimbursement timelines
Increase collections efficiency
Reduce efforts around claim corrections
Improve Revenue Cycle Performance
Definition
The percentage of electronic insurance claims submitted that are processed without errors or denials on the first submission.
Recommended Goal - 95% or higher
Higher Clean Claim Rates generally indicate:
Accurate insurance information
Strong verification workflows
Proper claim submission processes
Faster reimbursement timelines
Reduced Accounts Receivable aging
Lower Clean Claim Rates may indicate:
Incorrect insurance information
Missing attachments
Claim submission errors
Coordination of Benefits issues
Workflow inconsistencies
Production Adjustment Rate
Purpose
This KPI is used to measure how much of a practice’s gross production is being reduced through adjustments before collections are realized.
It helps practices understand the gap between Gross Production and Net Production.
Definition
Percentage of production adjustments compared to gross production over a specified period of time, calculated based on transaction date.
Recommended Goal - 3% or less
Lower Production Adjustment Rates may indicate:
Accurate fee schedules
Insurance plans that are properly set up
Higher Production Adjustment Rates generally indicate:
Production Adjustment Rates generally indicate:
Excessive write offs, possibly due to treatment errors, re-dos or professional courtesies
Out of date or Incorrect fee schedules
Inappropriate operational workflows
These KPIs, and many more related to RCM and other performance metrics, can be found within CareStack’s System Menu > Insights section. Example: Practice Analytics |
Additional Revenue Cycle Management KPIs and Reports can be found in:
Practice Analytics - Custom or Templated Dashboards
Operational Reports - Select business area Filters for easy navigation