"How is our billing doing?" is a hard question to answer with a feeling. It's an easy question to answer with the right numbers. The problem is that many OB/GYN practices receive reports that show activity — claims submitted, payments posted — without showing performance.
These are the twelve metrics we track for OB/GYN practices, how to calculate them, and what to do when they move in the wrong direction. A note before we start: published benchmarks vary widely by source, specialty mix and payer mix, so the most useful comparison is usually your own trend over time.
1. Net collection rate (NCR)
Formula: Payments ÷ (Gross charges − Contractual adjustments) × 100
What it tells you: How much of the money you're contractually entitled to you actually collected. Because contractual adjustments are removed, NCR isn't distorted by how high your fee schedule is.
When it drops: Look for unworked denials, timely-filing write-offs, underpayments, uncollected patient balances and small-balance write-offs. Use a rolling three- to six-month figure, matching payments to the charges they relate to as closely as your system allows.
2. Gross collection rate
Formula: Payments ÷ Gross charges × 100
What it tells you: Mostly how your fee schedule compares to what payers pay. It's not a performance measure on its own — a practice with high charges will always have a low gross collection rate. Watch it only for sudden changes.
3. Days in accounts receivable
Formula: Total A/R ÷ Average daily gross charges
(Average daily charges = last 3 months of gross charges ÷ number of days in those months.)
What it tells you: How long, on average, it takes to turn a charge into cash. Rising days in A/R signals slow submission, slow payers, or claims stuck in denial.
How to reduce it: Submit claims quickly, fix front-end errors, work denials within days, and follow up on unpaid claims before they age. See our tips in how to reduce days in A/R.
4. A/R over 90 days (% of total A/R)
Formula: A/R older than 90 days ÷ Total A/R × 100
What it tells you: How much of your receivables is at risk. The older a claim gets, the less likely it is to be collected — and the closer it gets to timely-filing and appeal deadlines.
Watch for: One or two payers holding most of your aged A/R. Breaking aged A/R down by payer and by denial reason makes the problem actionable.
5. First-pass acceptance rate (clean claim rate)
Formula: Claims paid on first submission ÷ Total claims submitted × 100
What it tells you: How often claims go out right the first time. Every claim that needs rework costs staff time and delays payment.
How to improve it: Stronger eligibility verification, claim scrubber rules for your most frequent rejection reasons, and coding feedback to providers.
6. Denial rate
Formula: Claims (or claim dollars) denied ÷ Claims (or dollars) submitted × 100
What it tells you: The overall volume of payer pushback. The total matters less than the breakdown by reason — eligibility, authorization, coding, bundling, timely filing, medical necessity — because each reason has a different fix.
7. Denial overturn (appeal success) rate
Formula: Denials successfully appealed or corrected ÷ Denials worked × 100
What it tells you: Whether your denial work is effective. A low overturn rate can mean appeals aren't well supported — or that many denials were correct and the real fix is upstream.
8. Charge lag
Formula: Average days from date of service to charge entry (or claim submission)
What it tells you: How quickly documentation becomes a claim. Long charge lag delays cash and pushes claims toward filing deadlines. Common causes: unsigned notes, coding backlogs, and surgical claims waiting for operative or pathology reports.
9. Patient collections at time of service
Formula: Patient payments collected at check-in/check-out ÷ Patient responsibility due at visit × 100
What it tells you: Whether your front desk is collecting copays and known balances up front. Patient balances become harder to collect after the visit, and statements cost money to send.
10. Open pregnancies and unbilled deliveries (OB-specific)
What to track: The number of active pregnancies by payer and expected delivery date, deliveries that haven't been billed, and patients who transferred out without an antepartum claim.
Why it matters: Under global billing (through 2026), obstetric revenue isn't visible in standard A/R until the claim is submitted. A practice can look healthy on A/R while thousands of dollars of obstetric care sit unbilled. See global maternity billing.
11. Time from delivery to claim submission (OB-specific)
What to track: Average days from delivery date to submission of the delivery (or global) claim.
Why it matters: Practices sometimes hold global claims until the postpartum visit, which can push them close to commercial timely-filing limits. Know each payer's policy and submit as early as it allows.
12. Surgical claims pending documentation
What to track: Hysterectomy and other surgical claims waiting for operative notes or pathology reports, and how long they've waited.
Why it matters: Uterine weight determines the hysterectomy code tier, so holding claims for pathology is correct — but they shouldn't wait indefinitely. A short list reviewed weekly keeps them moving. See GYN surgery coding.
Building a simple monthly KPI report
You don't need a fancy dashboard. One page, every month, with:
| Metric | This month | 3-month average | Same month last year | Trend |
|---|---|---|---|---|
| Net collection rate | ||||
| Days in A/R | ||||
| A/R over 90 days (%) | ||||
| First-pass acceptance | ||||
| Denial rate | ||||
| Top 5 denial reasons | ||||
| Charge lag (days) | ||||
| Open pregnancies / unbilled deliveries |
Add a short note on what changed and what you're doing about it. The note is often more valuable than the numbers.
Turning KPIs into action
- NCR down + denials up → work the denial breakdown by reason; fix the top two causes first.
- Days in A/R up + denials flat → check charge lag and payer payment timing; a single slow payer is common.
- A/R over 90 days rising → review aged claims against filing and appeal deadlines immediately.
- First-pass rate falling → add claim scrubber rules for the most common rejections; check for a recent payer policy change.
- Unbilled deliveries growing → review the pregnancy registry and delivery claim workflow.
Preparing your KPIs for 2027
When the global maternity package ends on January 1, 2027, prenatal visits will be billed per encounter. Expect more obstetric claims, earlier cash, and different patterns in A/R and denials. Set a baseline in late 2026 so you can see the effect clearly. Our 2027 maternity transition guide explains the changes.
Common reporting traps
KPIs are only as good as the data behind them. Watch for these distortions:
- Mixing time periods. Comparing this month's payments to this month's charges ignores payment lag. Use rolling averages or match payments to the charges they pay.
- Credit balances and refunds that inflate or deflate A/R. Clean them up regularly.
- Write-offs coded as contractual adjustments. If denials or timely-filing losses are written off as "contractual," your NCR will look better than reality. Use separate adjustment codes for each reason.
- Global OB claims not yet submitted. As noted above, they don't appear in A/R at all.
- Small-balance write-off policies that quietly absorb patient balances.
- Payer-level averages hiding provider-level problems. Look at denials by rendering provider too.
A reliable KPI report starts with consistent adjustment codes and a clear month-end process. If your current reports don't separate contractual adjustments from write-offs, that's the first thing to fix.
Want us to calculate your KPIs?
Send us a WhatsApp message. As part of our free audit, we'll calculate your current net collection rate, A/R aging and denial breakdown from your own data. You can also get a quick estimate with our revenue leakage calculator, or learn about our revenue cycle management service, which includes this reporting every month.
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Frequently asked questions
What is the most important billing KPI for an OB/GYN practice?
Net collection rate is usually the single best summary measure, because it shows how much of the money you're contractually owed you actually collect. It should be read alongside days in A/R and denial rate to understand why it's high or low.
How do you calculate days in A/R?
Divide total accounts receivable by your average daily gross charges. Average daily charges are typically calculated from the last three months of charges divided by the number of days in that period.
How often should we review billing KPIs?
Monthly, using rolling three-month averages for metrics that swing with payment timing. Denials and rejections are worth watching weekly.
Are there OB/GYN-specific KPIs?
Yes. Open pregnancies by payer, unbilled deliveries, time from delivery to claim submission and surgical claims waiting on pathology are all worth tracking in obstetric and surgical practices.
Disclaimer:This article is for general educational purposes and reflects coding rules and payer policies as we understand them on the date shown. Always confirm against the current CPT and ICD-10-CM code sets and your payers' published policies.
