Net revenue per visit: the number most owners can't answer

Ask a clinic owner what they get paid and you will hear a rate. "BCBS pays me $132." That is a real number, and it is not the one that runs the business. The number that runs the business is net revenue per visit: what you actually collect, on average, across every patient who walks through the door in a week, after the write-offs, the contractual adjustments, and the copays that never got collected. Most owners cannot say it out loud. The figure may sit on a report they already get, but the number in their head is the contracted rate, because that is the one they negotiated and the one that feels like getting paid.

Two things make the number slippery, and both are fixable.

Charges aren't collections

The rate on your fee schedule is a wish. The rate in your payer contract is a ceiling. What lands in the bank is neither. Net revenue per visit is total money collected divided by total visits, over a real period, say a quarter. Not charges. Collected. If you bill $200 a visit and collect $110, your number is $110, and the $90 was never yours to spend.

This is where a lot of owners quietly fool themselves. Gross charges look healthy. But the gross collection rate, payments over charges, is a quirk of your fee schedule, not a grade: down around 55% is normal, not a failure. The number that matters is simpler: dollars that cleared, divided by visits. Run it once and you have a figure you can manage.

You can move the number without adding a patient

Your net revenue per visit is not one rate. It is the weighted average of every payer you see, and those rates sit far apart. Commercial plans might land around $115 to $132. Medicare Part B pays less, Medicaid less still. Cash sits wherever your local market lets you set it, which for many clinics is below their commercial rate, not above it. Your blended number is just those rates, weighted by how much of each you see.

So the mix is a lever, not a fact of life. As a rule, workers' comp and auto pay the most, then commercial, then Medicare, then Medicaid. A five to ten point shift in your mix (a little more workers' comp, one renegotiated commercial contract) can beat any productivity gain you would sweat for on the floor. And there is no single national number to measure yourself against. Blended rates can range widely, from the $80s or lower to the $130s or higher, depending on your market and payer mix. So being "below average" means little when the average hides that much spread. Knowing your own number, and which payers move it, means everything.

What to do this week

Pull one quarter of collections and one quarter of visit counts, and divide. That is your real net revenue per visit. Write it down.

Then break it out by payer. You will find one or two lines dragging the blend down, and one or two you did not know were carrying you. You do not have to fire a payer to change the picture. Court a little more of the work that pays best, like workers' comp or auto. Ask your best commercial payer for the rate you should have negotiated two years ago. Then watch what a few points of mix does to the blend.

The honest part

Higher is not automatically the goal, and this is where phantom targets do real damage. Medicare and Medicaid sit below any commercial-weighted blend by design. That is structural, not a billing failure, and a clinic serving its community on those plans is not doing anything wrong. Chasing a made-up target can push you to drop patients you should keep.

And net revenue per visit is only the revenue side. What you keep per visit is that number minus what the visit costs you to deliver, and there is no honest national benchmark for cost per visit, so anyone selling you one is guessing. The number worth managing there is the one you compute from your own books. Know your blended rate, know roughly what a visit costs you, and the margin between the two is the business.

You cannot manage a number you cannot say. Say this one first.

Dash