EPISODE SUMMARY

In this final installment of the credentialing series, Jeremy and Kathryn Zug break down how practice owners can track and measure the success of their credentialing efforts using a KPI dashboard. They explore five essential KPIs—insurance revenue target analysis, time to contract, application completion accuracy, credentialing efficacy, and application denial reasons—and explain how each metric empowers you to make smarter business decisions. From identifying underperforming payers to training (not firing) staff, this episode shows how turning subjective frustration into objective data can transform your practice’s revenue cycle.

KEYWORDS

Credentialing KPIs, Revenue Cycle Management, Healthcare Practice Management, Insurance Denials, Credentialing Dashboard, Payer Relationships, Application Accuracy, Practice Solutions, Hourglass Learning Hub

TAKEAWAYS

Why KPIs Matter: Tracking metrics turns credentialing from a one-off task into an ongoing, data-driven process that strengthens both staff performance and payer partnerships.

The Five Credentialing KPIs:

Insurance Revenue Target Analysis – Ensure your payer mix supports profitability goals.

Time to Contract – Measure how long it takes to go in-network and optimize hiring timelines.

Application Completion Accuracy – Identify training needs or process gaps that slow down credentialing.

Credentialing Efficacy – Assess the percentage of successful applications by payer.

Application Denial Reasons – Drill down into whether denials are due to closed panels, errors, or qualifications.

Data = Better Decisions: KPIs help determine whether to retrain staff, refine payer lists, or renegotiate partnerships.

Case Study: A group practice avoided firing an employee by using KPI data to identify a training need—transforming her into a high-performing credentialer.

Practical Start: Don’t overcomplicate it—leverage the data you’re already collecting in your credentialing logs and EHR reports.

CHAPTERS

00:00 Introduction to Credentialing and Its Importance

02:31 Understanding Credentialing KPIs

04:33 Insurance Revenue Target Analysis: Tracking KPIs to Optimize Your Payer Mix

10:59 Time to Contract: Measuring Lead Times for Smarter Credentialing

16:36 Application Completion Accuracy: Pinpointing Errors, Patterns, and Process Gaps

22:11 Credentialing Efficacy: Measuring Success Rates by Payer

25:42 Application Denial Reasons: Uncovering Why Submissions Fail

29:49 Getting Started with Your Credentialing KPI Dashboard

34:12 Case Study: How Credentialing KPIs Turned an Underperformer Into a Key Asset

37:51 Conclusion: Turning Data Into Practice Growth

38:58 Introduction to The Claim Game Podcast

39:27 Engagement and Feedback from Listeners

39:54 Resources and Educational Opportunities

RESOURCES

The Hourglass Learning Hub: Dive deeper into RCM best practices and downloadable tools mentioned in this episode, like the various checklists and templates, by visiting The Hourglass Learning Hub.

Learn More About The Claim Game: Visit practicesol.com/podcast

Our Blog: Explore years of educational articles on billing and practice management at Practice Solutions Blog.

Book: For a comprehensive guide on navigating insurance, grab your copy of Insurance Billing Basics: Steps for Therapists to Successfully Take Insurance.

Get full access to The Claim Game at jeremyzug.substack.com/subscribe