{
  "title": "Actigy BPO RCM KPI Dictionary",
  "version": "2026-10-18",
  "note": "Working definitions. Follow the complete source specification for formal benchmarking.",
  "metrics": [
    {
      "id": "gross_ar_days",
      "name": "Gross days in AR (local gross-basis variant)",
      "formula": "Ending gross debit AR ÷ average daily gross charges",
      "unit": "days",
      "example_numerator": 90000,
      "example_denominator": 3000,
      "example_result": 30,
      "period": "90-day charges of $270,000 divided by 90 days",
      "exclusions": "Exclude credit balances; retain the same billing population. Local gross-basis variant; AAFP is background guidance, not the exact formula.",
      "reference": "local-gross-basis; aafp-background",
      "reference_url": "https://www.aafp.org/practice-operations/practice-finances",
      "subset": false
    },
    {
      "id": "net_ar_days",
      "name": "Net days in AR",
      "formula": "Ending net AR ÷ average daily net patient service revenue",
      "unit": "days",
      "example_numerator": 54000,
      "example_denominator": 1800,
      "example_result": 30,
      "period": "Net revenue of $162,000 over a 90-day example period",
      "exclusions": "Use net figures throughout; specify reserve treatment.",
      "reference": "hfma-map",
      "reference_url": "https://www.hfma.org/data-and-insights/map-initiative/map-keys/",
      "subset": false
    },
    {
      "id": "adjusted_collection",
      "name": "Adjusted collection rate",
      "formula": "Net payments ÷ charges after contractual adjustments × 100",
      "unit": "percent",
      "example_numerator": 190000,
      "example_denominator": 200000,
      "example_result": 95,
      "period": "12-month example: $240,000 charges less $40,000 contractual adjustments",
      "exclusions": "Do not deduct avoidable noncontractual write-offs from the collectible denominator.",
      "reference": "aafp",
      "reference_url": "https://www.aafp.org/practice-operations/practice-finances",
      "subset": false
    },
    {
      "id": "initial_denial_cohort",
      "name": "Initial denial incidence in a mature cohort",
      "formula": "Distinct original claims initially denied ÷ eligible original claims × 100",
      "unit": "percent",
      "example_numerator": 120,
      "example_denominator": 2000,
      "example_result": 6,
      "period": "One defined submission cohort with an agreed follow-up window",
      "exclusions": "Local cohort measure; not the HFMA reporting-month trend formula.",
      "reference": "local",
      "reference_url": null,
      "subset": true
    },
    {
      "id": "first_submission_acceptance",
      "name": "First submission acceptance",
      "formula": "Original claims accepted on first submission ÷ original claims submitted × 100",
      "unit": "percent",
      "example_numerator": 1840,
      "example_denominator": 2000,
      "example_result": 92,
      "period": "One submission cohort and one named acceptance endpoint",
      "exclusions": "Acceptance is not payment. Do not mix clearinghouse and payer events.",
      "reference": "local",
      "reference_url": null,
      "subset": true
    },
    {
      "id": "aged_ar",
      "name": "Billed AR older than 90 days",
      "formula": "Billed debit AR in the 91-day-and-older buckets ÷ total billed debit AR × 100",
      "unit": "percent",
      "example_numerator": 13500,
      "example_denominator": 90000,
      "example_result": 15,
      "period": "Single snapshot with a declared aging start date",
      "exclusions": "Exclude credit balances consistently; keep unbilled work separate.",
      "reference": "local",
      "reference_url": null,
      "subset": true
    },
    {
      "id": "denial_writeoffs",
      "name": "Denial write-off ratio",
      "formula": "Denial write-offs net of recoveries ÷ net patient service revenue × 100",
      "unit": "percent",
      "example_numerator": 3600,
      "example_denominator": 180000,
      "example_result": 2,
      "period": "Same reporting month for this local operating ratio",
      "exclusions": "Not a claim-count measure; state period and net-revenue convention.",
      "reference": "local",
      "reference_url": null,
      "subset": false
    },
    {
      "id": "cost_collect",
      "name": "Cost to collect",
      "formula": "Defined revenue cycle operating cost ÷ patient cash collections × 100",
      "unit": "percent",
      "example_numerator": 7200,
      "example_denominator": 180000,
      "example_result": 4,
      "period": "Same reporting period with a documented cost perimeter",
      "exclusions": "Include retained staff, outsourced work and systems consistently.",
      "reference": "local",
      "reference_url": null,
      "subset": false
    },
    {
      "id": "appeal_favorable",
      "name": "Favorable appeal outcome share",
      "formula": "Decided appeals with a favorable outcome ÷ all decided appeals × 100",
      "unit": "percent",
      "example_numerator": 45,
      "example_denominator": 60,
      "example_result": 75,
      "period": "One appeal cohort; disclose pending appeals separately",
      "exclusions": "Define partial reversals. A favorable decision is not necessarily cash received.",
      "reference": "local",
      "reference_url": null,
      "subset": true
    },
    {
      "id": "human_effort",
      "name": "Human effort per handled item",
      "formula": "Total production review correction and escalation minutes ÷ handled items",
      "unit": "minutes",
      "example_numerator": 9600,
      "example_denominator": 2000,
      "example_result": 4.8,
      "period": "One queue and reporting period",
      "exclusions": "Disclose excluded work and tool coverage; include review time.",
      "reference": "local",
      "reference_url": null,
      "subset": false
    }
  ]
}