Why Cost Per Successful Payment Should Replace Denial Rate
In this guide, we break down why denial rate stops being useful once a team is already hitting it and what to track instead. You’ll see how a claim that’s
Most RCM reporting stops at claim status: paid, denied, pending. That tells you where a claim sits, but not why it got there or who moved it. MedEvolve layers human work-effort data — every action a staff member takes on a claim — on top of your existing EMR and PM system data. The result is a side-by-side view of activity and outcome, so leaders can finally see which behaviors are protecting margin and which ones are quietly eroding it.
AR days and clean claim rate were built for a slower, less automated revenue cycle. Under today’s regulatory and reimbursement pressure — including the shifts introduced by OBBBA — they no longer tell leaders what to fix or who needs coaching. Effective Intelligence® replaces them with three operational benchmarks designed for how work actually gets done:
Zero-touch rate — the share of claims that resolve without any manual staff intervention
First-touch payment rate — how often a claim is paid after the very first staff action, with no rework
Touches-to-resolution — the average number of staff actions it takes to close out a claim, by payer, biller, and denial reason
Together, these benchmarks give revenue cycle leaders a live, apples-to-apples read on staff effectiveness that legacy metrics were never built to provide.
A behavioral health provider used this same touch-level data to expose where claims were stalling, hold specific team members accountable to the new benchmarks, and reverse a declining collections trend — without adding headcount. It’s one example of what becomes possible once work effort and financial outcome live in the same report.
labor cost reduction
fewer avoidable touches
First touch payment rates
added in zero touch revenue
What do the reports show? They show exactly where and why humans are getting involved in the claim cycle—who touched what, when, and whether it drove payment. That meant finally seeing the hidden costs, inefficiencies, and accountability gaps dragging down performance.
“MedEvolve solutions have been a game changer for our revenue cycle processes. Now, we have the workflow automation and advanced analytics tools needed to really understand performance improvement drivers within our revenue cycle teams and processes.”
Chief Financial Officer
“The power of the revenue cycle focused data intelligence gave us the ability to quickly identify issues and then utilize workflow to find specific examples and quickly resolve cases. A new team member identified two major issues within her first four days of using the system.”
Sr. Director Revenue Optimization
MedEvolve empowers healthcare organizations with award-winning Effective Intelligence (Ei) solutions. MedEvolve’s Ei solutions include workforce automation and intelligent analytics designed to optimize the entire revenue cycle process from financial clearance to medical billing. With our generative AI engine, these solutions can pin-point exactly where changes are happening in the revenue cycle, good or bad, and tell you why. We do this by tracking and measuring the human generated data – every touch your staff is making in the revenue cycle in the attempt to adjudicate claims.
Reduce RCM labor dependence with financial clearance, insurance A/R, & patient A/R automation modules with real-time analytics.
Increase productivity and simplify front & back office processes while keeping your staff focused with our flagship PM system.
In this guide, we break down why denial rate stops being useful once a team is already hitting it and what to track instead. You’ll see how a claim that’s
A team can spend 40 hours resolving 200 claims, watch 180 of them pay, and still report a comfortable 8 percent denial rate. That number doesn’t tell you what it
Hospitals and health systems spend an estimated $40 billion a year on billing and collections. A system replacement changes the interface, not necessarily the economics.
In this guide, MedEvolve breaks
Most AI vendor pitches are built around task-completion metrics: claims processed, calls placed, codes assigned, denials ‘worked.’ These numbers are easy to demo and easy to report. They are also,
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