Glossary · KPIs
Glossary · KPIsFirst-Pass Resolution Rate
The percentage of claims that resolve to a final disposition (paid or written off) without any post-submission rework. Stricter than clean-claim rate, which only measures initial acceptance.
Definition
First-Pass Resolution Rate.
The percentage of claims that resolve to a final disposition (paid or written off) without any post-submission rework. Stricter than clean-claim rate, which only measures initial acceptance.
Formula
(Claims resolved without rework ÷ Total claims submitted) × 100
Industry benchmark
Healthy: 90%+. Best-in-class: 95%+.
Sources
Primary references for this entry.
- HFMA MAP Keys.
- MGMA Cost and Revenue Survey.
Related terms
Other terms in KPIs.
- KPIs
Clean Claim Rate
The percentage of claims accepted by the payer on first submission without rework. The single most-cited revenue cycle KPI for measuring billing operation quality.
Open entry - KPIs
Cost to Collect
The total operating expense required to collect each dollar of patient revenue, including billing salaries, software, denial-rework labor, and outsourced vendor fees.
Open entry - KPIs
Days in A/R
A measure of how long, on average, it takes a practice to collect payment after the date of service. The primary cash-flow KPI in revenue cycle management.
Open entry - KPIs
Denial Rate
The percentage of submitted claims initially rejected by the payer before any rework or appeals.
Open entry - KPIs
Gross Collection Rate
Total payments collected as a percentage of total billed charges. A weak quality indicator on its own because it depends on chargemaster pricing.
Open entry - KPIs
Net Collection Rate
Collected revenue as a percentage of allowed amount, after contractual adjustments. The most rigorous measure of revenue-cycle effectiveness because it strips out chargemaster pricing.
Open entry
Frequently asked
About First-Pass Resolution Rate.
Talk to RCM
Ready to recover every dollar your practice earns?
See your projected revenue lift in 60 seconds, or talk to a senior RCM strategist now. No commitment. Same-day slots available.
- 30-day parallel-run guarantee
- Targets written into the contract
- HIPAA · SOC 2 Type II · HITRUST