AAFP members can ask a question at the Practice Management Help Desk.
Asia Blunt, MBA, CPC
Practice Management Strategist
Take six minutes to better understand and be able to calculate the average amount your practice should be collecting from submitted claims. After watching this presentation, you will know how to:
The average reimbursement rate represents the average amount your practice collects from the total claims submitted. When tracked over time and compared with historical practice results, it provides an accurate picture of your practice’s financial health. It also helps determine if your practice could realistically bring in more revenue. Claim-specific negotiated discounts, payment bundling, and bad debt can adversely affect average reimbursement rate.
Best Practice Tip
The industry average is 35% to 40%.
To calculate the average reimbursement rate, divide the sum of total payments by the sum of total submitted charges/claims.
To calculate the average reimbursement rate per encounter, divide the sum of total payments within a given period by the number of encounters within the same period.
Calculating the average reimbursement solely for all payers together. Calculate the average reimbursement rate for each payer to determine how each payer is compensating your practice. If possible, payments should be sorted by payer and procedure to determine the most common procedures submitted to each payer and the paid percentage for those procedures.
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Average Reimbursement Rate