Revenue cycle success is often determined by those metrics that leaders don’t see — or don’t have time to investigate.

In a recent episode of the MGMA Insights Podcast, Sr. Editor and host Daniel Williams sat down with Aaqil Khan, RCM consultant at Collectly, to explore the overlooked KPIs quietly eroding collection performance.
Khan explains how estimate accuracy, collection conversion rates, patient A/R days, and friction within the payment journey can create losses that dashboard metrics simply don’t reveal.

For medical practice leaders juggling administrative demands, staffing pressures, and rising patient responsibility, understanding these “sneaky” metrics is essential for sustainable financial performance.

A path shaped by personal loss and purpose

Khan’s journey into revenue cycle leadership began far from spreadsheets and KPIs.

“I actually did my undergraduate degree in molecular and cellular biology,” he said. “My goal was always to go into medicine and become a doctor.”

His plans changed after his father, a practicing physician, died unexpectedly in a boating accident during Khan’s sophomore year. The loss shifted his perspective on what a career in healthcare could be.

Before that moment, he had grown up surrounded by strong cultural expectations about becoming a physician.
As he joked in the interview, “For those who are on video, I'm Indian. And if you're Indian, you have to either become a doctor, an attorney, or a lawyer, or your parents didn't think you made it, right?”

That pressure shaped his early ambition to pursue medicine and sit for the MCAT, but his father’s passing changed how he thought about impact, purpose, and the type of career he wanted to build.

“I governed my life by an effort versus impact ratio,” Khan said, reflecting on his decision to explore the administrative side of healthcare. He realized he could influence healthcare delivery at scale by improving workflows, analytics, and financial systems — a path that ultimately led him into revenue cycle leadership and to his current role at Collectly.

Why essential KPIs slip through the cracks

Even the most important revenue cycle metrics — eligibility verification, estimate accuracy, collection rates, A/R days — are often inconsistently monitored.

Khan says it’s not about apathy.

“I used to come into the office with this beautiful plan to sit down and tackle these two, three, four, five objectives for the day,” he said. “And then it's the knock, knock on the door… and everything that you thought you were going to get done for the day is out the window.”

Daily fires consume time and attention. System connectivity issues create data inconsistencies, and unclear KPI definitions make measurement almost impossible. Even when the data is accurate, responsibility may not be. “It's fragmented ownership,” Khan explained.

Departments assume someone else is accountable, leaving no single point of responsibility. This lack of clarity can mask performance issues for months.

The high cost of estimate inaccuracy

One of the most overlooked revenue cycle metrics is estimate accuracy, Kahn said. “Estimates are starting to become really important, and patients are demanding that transparency."

He emphasized that practices must understand how far off their estimates truly are.

“How off are you? Are you wildly off? Are you slightly off?” he asked. The answer, he explained, has consequences across the entire financial journey. “Inaccuracy ultimately creates bill shock,” he noted.

That bill shock erodes trust before the billing process even begins.

Patients who expected to pay one amount quickly lose confidence when the final bill looks different. The disconnect forces staff into reactive work, fielding questions and clarifying discrepancies. Collection efforts slow as patients pause, push payments back, or begin disputing balances. A/R grows as accounts linger — not because patients refuse to pay, but because they don’t understand the charges.

Khan sees this friction as entirely avoidable.

In his experience, poor estimate accuracy is rarely about capability and more often about definition, workflow, or accountability. It’s a reminder that calculations alone aren’t enough — they have to be correct, consistent, and communicated clearly.

And in today’s consumer landscape, the stakes are higher than ever.

Why patient collection rates can be deceptive

High collection totals can give leaders a false sense of success. Khan warns that dollar‑based metrics often conceal underperformance.

“It can look good from a dollar standpoint, but it may be failing as a conversion rate,” he said.

He explained that when leaders don’t break the metric apart, they miss where the real problems live.

“You want to really start to, again, further segment those definitions to figure out where is the actual problem,” Khan said. He emphasized that without segmentation, “that can sometimes be a very gray area.”

To illustrate the point, Khan shared an example from his first revenue cycle leadership role. When he took over, the team launched a competition to encourage co‑pay collections.

“And guess who was winning that competition every time?” he said. “ER surgery, because their co‑pays were a lot larger.”

The numbers seemed impressive — until he applied a conversion‑rate lens.

“But when you looked at a conversion rate, you could look at the clinics and they had an opportunity to collect, say, in a day, $1,200 in co‑pays and they collected 70 of them,” he explained.

Meanwhile, departments with much larger individual co‑pays had fewer opportunities and often underperformed on conversions. It revealed that the highest dollar totals weren’t the strongest performers — they were simply the departments handling the highest‑priced co‑pays.

Khan used the moment to reinforce why surface‑level data can mislead operational strategy. 

“That’s something to look at,” he said. "That definition again." He noted that leaders must distinguish between dollars and conversion behavior to understand real performance.

This is where segmentation matters: pre‑service, point‑of‑service, and post‑service conversions tell different stories. The solution is not just measuring dollars collected but understanding how many opportunities were acted on — and where breakdowns occur.

Friction creates financial losses and patient attrition

Khan emphasizes that patient experience directly drives payment performance.

“Anytime you introduce an app to download or a username and password to remember… you're ruining the patient experience,” he said. “It’s making it difficult to pay.”

Every friction point increases the likelihood of delayed or abandoned payments.

“The last thing we can do right now is give patients a reason to not complete that payment journey,” he added.
Friction also affects retention.

As Khan noted, patient loyalty is “out the window” in today’s consumer‑driven environment. A confusing or burdensome payment process can be just as damaging as long wait times or poor bedside manner. Friction doesn’t just delay payments, it pushes patients away.

The hidden A/R metrics most leaders miss

One of Khan’s most telling examples came from a multi‑state specialty practice whose high‑level metrics appeared stable. 

“Overall collections weren’t alarming,” he said. But the deeper operational signals told a different story.

Patient A/R days were quietly creeping upward, call volumes were rising every time statements went out, and support teams noticed that patients were calling back repeatedly about the same balances.

Khan said the initial assumption was that the issue might be affordability or payer mix. But as he dug deeper, he realized the pattern didn’t match those explanations.

Patients were receiving multiple bills from different care settings — clinics, surgery centers, hospital‑based services — yet every bill looked the same.

“They thought they were paying everything, but the payments were only being applied to certain areas,” he explained. The lack of differentiation meant patients couldn’t tell which bill was connected to which visit or which service line.

The result was confusion, frustration, and repeated inquiries. What am I looking at? became the most common question. Where patients saw a single provider, the organization’s internal structure generated separate balances that felt disconnected and opaque.

Khan emphasized that the dashboard failed to reveal the true problem because traditional metrics don’t measure patient effort.

“We really weren’t looking at the touches it took to resolve a simple balance question,” he said. That metric — touches per account — became the turning point. It showed that the problem wasn’t collections, it was lack of clarity.

Once the organization simplified its statements and improved digital explanations, they saw immediate results:

• Call volume dropped by 35%. 
• Balances were resolved faster because patients finally understood what they were paying for.
• First‑pass payment rates increased as friction disappeared from the process.

Without measuring these informational gaps, leaders never see the friction until it reaches their support lines.

Preparing for a future led by automation and behavior analytics

Looking ahead, Khan believes automation and behavioral insights will define the next era of revenue cycle efficiency.

“With Collectly, we can see when they clicked, what time they went in, how far they went into the screen, if they dropped off,” he explained.

This level of detail allows for personalized outreach and friction‑free payment experiences. Digital adoption metrics — deliverability, click‑through rates, payment completion — are becoming as important to RCM as traditional accounting measures.

As deductibles rise and patient responsibility grows, these insights help practices reduce cost‑to‑collect and remove barriers before they become operational bottlenecks.

To stay ahead, Khan encourages leaders to monitor automation effectiveness, payment plan default rates, and digital engagement across demographic groups.

TL;DR: Practical takeaways

• Start by defining KPIs clearly and assigning true ownership.
• Regularly audit estimate accuracy to prevent bill shock.
• Measure patient collection conversion rates — not just dollars.
• Reduce friction in payment workflows to improve satisfaction and A/R.
• Track patient A/R days alongside inquiry volume to uncover hidden issues.
• Invest in automation and behavioral analytics to streamline collections.
• Prioritize digital payment adoption as paper statements decline.
• Align RCM strategy with rising patient responsibility and shifting expectations.

Resources

• Contact Aaqil on LinkedIn
• Collectly 
• MGMA Revenue Cycle Management Resources
• “All the Queen’s Horses” documentary on Amazon Prime 
  (Local scandal of Rita Crundwell mentioned in Aaqil's introduction)