Answer Each Question

Clean claim rate1. What share of claims are accepted by the payer on first submission, without correction?

Above 95 percent

90 to 95 percent

80 to 89 percent

Below 80 percent or unknown

Days in A/R2. What are your average days in accounts receivable?

Under 35 days

35 to 45 days

46 to 60 days

Over 60 days or unknown

Denial rate3. What is your overall claim denial rate?

Under 5 percent

5 to 8 percent

9 to 12 percent

Above 12 percent or unknown

Prior authorization workflow4. How is prior authorization tracked and confirmed before the visit or procedure?

Dedicated staff verify and document every case before service

Front desk checks most cases, occasional gaps

Handled reactively when a denial appears

Eligibility verification5. When is insurance eligibility verified relative to the appointment?

Electronically verified before every visit

Verified at check-in for most visits

Verified only when a problem is suspected

Coding review6. How are claims reviewed for coding accuracy before submission?

Independent coding review or audit on a regular schedule

Spot checks on high-risk codes only

No independent review, physician or biller codes are submitted as entered

Denial rate7. Are denials categorized by root cause and tracked over time?

Yes, categorized and reviewed monthly with the team

Denials are tracked but not categorized or reviewed regularly

No systematic tracking

Denial rate8. What share of denied claims are appealed?

Nearly all eligible denials are appealed

Higher-dollar denials are appealed, smaller ones written off

Appeals happen inconsistently or rarely

Patient collections9. How are patient balances collected after insurance adjudication?

Point-of-service collection plus a structured statement and follow-up cycle

Statements go out but follow-up is inconsistent

No structured process, balances accumulate

Write-off governance10. Who approves write-offs and adjustments, and is that authority documented?

Written policy with defined approval thresholds and regular audit

Informal approval by a manager, no written policy

Staff can write off balances without oversight

Days in A/R11. Is your days in A/R trending better, worse, or flat over the past year?

Improving

Flat

Worsening or not tracked

Clean claim rate12. Do you receive and act on payer-specific rejection reason data, not just a total denial count?

Yes, reviewed by payer and reason code regularly

We see totals but not the reason detail

No visibility into reason codes

Your Score

Answered 0 of 12 questions. Complete every question for a final score.

How This Works

Each question is weighted toward the workflow controls that most directly affect clean claim rate, days in accounts receivable, and denial rate: eligibility verification, prior authorization, coding review, appeal follow-through, patient collections, and write-off governance. Scores are summed and expressed as a percentage of the maximum possible score, then mapped to a letter grade band.

This is a self-reported screening tool, not an audit of your billing system data. The percentage thresholds used in the individual questions, such as the definition of a strong clean claim rate or an acceptable days in A/R range, reflect commonly cited industry operating targets rather than a single named dataset. Treat your result as a directional signal, and use it to prioritize where a deeper revenue cycle review is warranted.

Questions About This Self-Audit

What is a good denial rate for a medical practice?

Many revenue cycle teams target a denial rate under 5 percent as a strong result and treat rates above 12 percent as a sign of systemic workflow failure. This self-audit uses those bands as scoring thresholds, but your own trend over time matters more than any single external number.

What is a clean claim rate and why does it matter?

Clean claim rate is the share of claims accepted by the payer on first submission with no correction needed. A low clean claim rate means staff time is spent reworking claims instead of processing new ones, which slows the entire revenue cycle.

Why does this audit ask about write-off governance?

Write-offs without documented approval thresholds are a common place where legitimate collectible revenue disappears quietly, and where compliance risk accumulates if adjustments are not applied consistently.

How is the score calculated?

Each question is scored based on the option you select, and the scores are summed and converted to a percentage of the maximum possible score, then mapped to a letter grade band from A to F.

Does a low score mean the practice is in financial trouble?

Not necessarily. It means specific revenue cycle workflows carry more risk than they should. Practices with a low score can usually improve significantly within a few operating cycles once the two or three weakest areas are addressed in sequence.

Turn Your Score Into a Revenue Cycle Plan

We can validate this self-reported score against your actual claims data and build a sequenced plan to close the gaps.

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Revenue Cycle Denial Risk Self-Audit