6 Billing Metrics Every Pediatric Practice Should Track

Clean Claim Rate: The Foundation of Faster Payment

A clean claim is one that gets accepted on first submission without needing corrections, additional documentation, or appeals. These are your rejections and the clean claim rate is considered a foundational billing performance indicator. It reflects how well your billing process works before the claim ever reaches the payer. A higher clean claim rate means fewer delays, less administrative work, and a smoother path to reimbursement.

Pediatric practices should aim to keep this rate as close to 95% as possible. While that benchmark is widely accepted, many practices fall short due to issues such as outdated coding, inconsistent eligibility verification, or unoptimized EHR systems. Even a modest drop in this rate leads to longer accounts receivable cycles and more time spent on avoidable rework.

Improving this metric often starts with simple, consistent steps—verifying insurance before every visit, updating CPT codes regularly, and using claim scrubbers that detect common pediatric errors. These efforts not only raise your clean claim rate but also help prevent downstream issues like denials and payment delays. Our services include a rejection analysis as part of a comprehensive review process.

Days in A/R: Understanding How Long It Takes to Get Paid

Days in accounts receivable (A/R) shows the average time between providing a service and receiving payment. For pediatric practices, this number can vary depending on the patient mix—commercial payers often reimburse more quickly, while Medicaid payments take longer to process. Understanding your days in A/R gives you insight into overall cash flow and how efficiently your revenue cycle is operating.

An A/R average over 40 days could mean slow claims processing, inconsistent follow-up on aging balances, or systemic issues in how claims are submitted. Even when overall A/R appears reasonable, a deeper dive into aging buckets can reveal trouble. If a large portion of your revenue sits unpaid after 90 days, it’s likely slipping through the cracks.

By setting targets and comparing them to payer expectations, you can begin adjusting workflows or following up sooner. Practices that regularly review A/R data often find they’re able to identify recurring bottlenecks—whether they stem from staff, systems, or payer behavior. Connecting these trends to your broader denial management process helps reinforce a proactive billing strategy.

Percentage of A/R Over 90 Days: The Cost of Delayed Payments
Once a claim reaches the 90-day mark, the odds of collecting on it drop significantly. That’s why the percentage of accounts receivable over 90 days is such a critical indicator of billing health. The Medical Group Management Association (MGMA) sets a general benchmark of keeping this under 15%, but we believe pediatric practices should aim much lower—ideally under 5%, and in high-performing practices, even under 3%.

A high percentage in this category is a red flag that something is slipping. It could point to a front-end issue with claim submission, a payer that’s slow or difficult to work with, or patient balances that aren’t being pursued. Identifying the root cause is essential. The longer money sits in A/R, the more resources you spend trying to recover it—and the more likely it is to be written off. By targeting this metric and pairing it with payer-specific analysis, practices can tighten their processes and accelerate payments.

Unpaid Vaccines and Office Visits: Don’t Let Revenue Walk Out the Door

Vaccines and office visits are the bread and butter of pediatric care—but they’re also some of the most commonly denied charges. Payers may reject them for reasons like bundling, modifier issues, or coordination of benefits problems. Left unchecked, these denials lead to lost revenue and can quickly erode your bottom line.

That’s why it’s essential to track unpaid visits and vaccines closely, ensure denials are appealed, and avoid premature write-offs. These aren’t optional services—they’re core to your practice’s mission and sustainability. When vaccines go unpaid, you’re not just missing revenue—you’re paying out of pocket to deliver care. Educating your billing team, tightening your appeals process, and confirming proper use of codes and modifiers can dramatically improve reimbursement on these essential services.

Net Collection Rate: Measuring What You Actually Collect

Net collection rate tells you how effectively your practice collects revenue based on what payers allow, not just what you charge. It subtracts contractual adjustments and zeroes in on how much of the expected payment you’re actually bringing in. This makes it one of the most accurate indicators of revenue cycle performance.

Practices that consistently track net collections tend to spot problems sooner, like under-collecting from patients, slow responses to denials, or missed follow-ups. A healthy net collection rate typically falls between 95% and 99%. If you’re coming in below that range, it’s worth examining front desk collections, timely filing habits, and how well staff understand payer-specific reimbursement rules.

Raising your net collection rate doesn’t necessarily require working harder. Often, it comes down to fixing common gaps in communication, improving documentation habits, and refining workflows. These are the same areas that, when neglected, can cause coding errors and unnecessary write-offs. Our team works with pediatric providers to bridge those gaps and drive stronger revenue outcomes.

 

Billing Lag Time: How Delays Add Up

Billing lag time measures the gap between the date of service and the date a claim is submitted. In an ideal workflow, claims go out the next business day. But in many practices, delays occur—whether it’s from providers not closing notes, clinical staff leaving tasks incomplete, or billing teams not submitting claims daily.

Every extra day between service and submission slows down payment, extends your A/R cycle, and masks the true efficiency of your billing process. It also makes it harder to catch and resolve errors quickly. Because this metric touches every part of your workflow—providers, front desk, clinical team, and billing—it’s a powerful indicator of overall operational health. Tracking it regularly helps uncover bottlenecks and creates accountability across the team, ensuring claims don’t just get billed correctly—they get billed promptly.

How to Track and Use These Metrics Effectively

Tracking these six metrics requires more than just dashboards—it requires regular review, shared accountability, and process adjustments. It’s not enough to generate reports. You need to use that data to identify trends, assess performance, and guide operational changes across billing and clinical teams.

Start by benchmarking where your practice stands. Then assign ownership of each metric to someone who can review it consistently and take action when it trends in the wrong direction. Practices that do this often discover areas of opportunity they hadn’t previously considered—like automation gaps, over-reliance on manual coding, or training issues affecting documentation quality.

This type of metric-based oversight ties directly into bigger financial strategies. It complements work already being done around fee schedule evaluation, denied claims resolution, and improving front-desk efficiency. When your team views these metrics as part of a cohesive financial picture, billing transforms from a back-office task to a driver of growth. If you’re ready to assess your metrics more closely, contact us to learn how we can help.