A revenue-cycle scorecard for outpatient practices. Benchmarks against MGMA DataDive, calculated the same way your peers calculate them.
Get your scorecardClinicRev is a revenue-cycle KPI methodology site for outpatient practices. We use the same definitions MGMA uses in DataDive so practices can benchmark against peers without arguing about denominators. The calculators on this page are the same ones we use in scorecards.
Vendors often redefine KPIs to make their numbers look better. We use MGMA's denominators so your scorecard matches DataDive.
Total A/R divided by avg daily charges (rolling 90-day). Excludes credit balances. Banded against MGMA quartiles.
Initial = first-pass denials over submitted. Final = unrecovered over submitted. The gap is your appeal effectiveness.
Claims paid in full on first submission over total submitted. Better-performers exceed 95% — many practices sit at 80-85% and don't know it.
Total RCM cost (in-house or vendor) over net collections. Outpatient benchmark is 3-6% of NPSR.
MGMA-aligned formula. Banded against better-performer, median, and challenged quartiles.
Initial vs final denial rate with recovery percentage and MGMA benchmark comparison.
Credit balances inflate days-in-A/R denominators and mask poor follow-up. MGMA DataDive uses net A/R (excluding credits) so practices comparing themselves to peers should do the same.
Both. Initial tells you how clean your front-end is; final tells you whether your appeals team works. A 12% initial with 1% final means strong appeals; 12% initial with 9% final means denials are being written off.
Clean claim rate counts claims that pass scrubbing. First-pass yield counts claims paid in full on first submission. Many clean claims still get partial payment or zero — yield catches that.
Monthly, with the 90-day rolling average. Weekly is noisy; quarterly is too lagging to catch problems.
3-6% of net patient service revenue for outpatient. Above 8% usually signals over-staffing, under-automation, or a poorly-matched vendor contract.
Yes — for practices we work with, we produce a monthly scorecard with the four KPIs above plus payer-mix and CPT-level yield. Reach out via the form.
Send a remit sample (835s) and we'll return a benchmarked scorecard within 5 business days. No software install.
A plain-language walkthrough of the entire RCM cycle—from pre-auth to patient pay—and the KPIs every RCM lead should track.
CARC and RARC explained, with a walkthrough of the denial codes RCM teams see most—and how to triage each one.
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