The new year offers retina practices an opportunity to pause and reset. While many factors are in play—including shifts in patient volume, deductible resets, fee schedule changes, and increased payer scrutiny—the necessary first step is to review where the practice stood last year and determine what actions are needed now. Most practices respond by running reports. Fewer take the next step: interpreting those numbers to guide operational, financial, and compliance performance.
Key performance indicators (KPIs) are not scorecards, although they are often treated as such. When thoughtfully selected, however, they function as early warning systems, revealing inefficiencies, risks, or revenue leakage that may already exist or be emerging. The goal is not to track more data, but to track the data that accurately reflect practice performance and provides actionable insight.
Below are core KPIs retina practices can use to implement changes, if needed, early in the new year, with an emphasis on what each metric reveals and how it can be applied constructively. Warning: Avoid changing too many metrics at once. Be thoughtful about the potential impact and whether the practice has the capacity to monitor those metrics closely enough to determine whether it is moving in the right direction.
KPI #1: Charge Lag and Documentation Timeliness
Timely (and accurate) documentation is foundational to clean claims and compliant billing.
What to review:
- Time from encounter to charge entry
- Time to finalize documentation
- Physician-level variation (including by location)
Why it matters:
Among all the KPIs, this one can quickly affect accounts receivable (AR). Consistent delays in physicians completing chart notes or submitting claims increase days in AR and disrupt revenue. These patterns often reflect process issues in clinic design, staffing support, or workflow, not necessarily individual performance. The start of a new year is the proper time to review and revise the process.
KPI #2: Days in Accounts Receivable
Days in AR remains a reliable indicator of revenue cycle performance, especially at the start of the year when deductibles reset. It is critical to review the AR for service fees separately from drug fees, as well as the aggregate.
What to review:
- Total days in AR
- AR aging over 60, 90, and 120 days
- Payer-specific AR trends
Why it matters:
Breaking this KPI down by payer, physician, location, and patient level provides additional detail to identify issues. This breakdown helps separate process and system problems—such as inactive insurance, missing prior authorization, requests for additional documentation, or inefficient follow-up processes—from payer issues. The review should provide insights into specific concerns or issues that can be acted upon.
KPI #3: Net Collection Rate (Adjusted)
This KPI evaluates how efficiently the practice collects the revenue it is legally entitled to after contractual adjustments. It offers a more accurate view of revenue integrity than the gross collection rate and helps uncover revenue losses that may not be reflected as denials.
What to review:
- Net collection rate overall and by payer category
- Trends over time rather than single-month snapshots
- Correlation with A/R aging and denial categories
Why it matters:
High drug costs and payer variability can amplify collection gaps. A declining net collection rate often signals underpayments, missed secondary billing, or inconsistent follow-up. These are issues that denial rates alone may not capture. Reviewing this KPI helps confirm whether clean claims are converting into the expected revenue.
KPI #4: Denial Rates by Category
Overall denial rates offer limited insight. Meaningful analysis requires categorizing denials.
What to review:
- Medical necessity denials
- Coding-related denials
- Eligibility and authorization denials
Why it matters:
Each denial category points to a distinct root cause and requires a tailored solution, rather than treating all denials the same way, which can hinder improvement and increase rework of claims. A review early in the year allows practices to intervene upstream.
KPI #5: Utilization of Office Visits for Physician and Location
The use of office visit types is typically reviewed in aggregate, but the real value emerges when reviewed by physician and location. This KPI examines how different visit types are distributed across the practice and whether those patterns are consistent or variable.
What to review:
- Distribution of visit types by physician
- Eye Codes vs E/M codes
- Use of complexity or add-on services
Why it matters:
When physicians within the same practice display significantly different patterns, the issue is seldom clinical. Monitoring utilization offers valuable insights for accurate documentation. The first quarter is an optimal time to review these patterns.
KPI #6: Modifier Utilization Rates
Modifier usage is one of the most visible signals to payers and auditors. High or inconsistent modifier use invites scrutiny, regardless of clinical intent.
What to review:
- Modifier frequency by physician
- Variation across locations
- Month-over-month trends
Why it matters:
Whether there is wide or slight variation among physicians performing similar work, there is an inherent risk associated with improper modifier use. Ensuring medical necessity and supportive documentation are in place is critical. Identifying these patterns early allows for targeted education and process alignment before denials or audits force the conversation.
KPI #7: Internal (and External) Audit Findings
Chart audit results offer more than compliance insights; they reveal documentation and revenue risks.
What to review:
- Common documentation gaps
- Recurrent coding errors
- Repeat findings across audits
Why it matters:
Patterns matter more than isolated errors. February is an ideal time to use prior audit findings to guide focused education and process improvements, rather than broad retraining that has little impact.
KPIs as Guardrails, Not Scorecards
KPIs are most effective when they function as early warning signals rather than performance grades. In retina practices, they help identify operational issues such as documentation delays, staffing strain, and workflow bottlenecks before these problems escalate into denials, audits, or burnout.
When reviewed early in the year and again on a quarterly basis, KPIs help practices confirm what is working, identify where workflows are slipping, and make targeted adjustments. Used correctly, KPIs support quality care and operational sustainability by enabling practices to act sooner rather than later. RP