Urgent Care Revenue Cycle Management Tips

Urgent Care Revenue Cycle Management Tips

The Urgent Care industry is going from strength to Strength. What’s been driving this growth is their ability to provide affordable, efficient and quick medical care. This trend is sure to continue and as per projections the industry will hit $21 billion by 2020.

On one hand the industry is booming and on the other hand a lot of clinics are complaining of shrinking profit margins. A lot of this has to do with the inefficiencies in their revenue cycle management processes. The challenges are many ranging from technological deficiencies to lack of billing & coding expertise. Urgent Care clinics must pay close attention to their revenue cycle performance for them to continue being profitable. Cosentus believes every Urgent Care clinic must pay close attention to these 4 areas for maximize their revenue.

Area#1 Front End Driven Process

The revenue cycle for an Urgent Care starts at the time the patient walks in. A really well-organized front desk operation is both required and beneficial. Right from a warm reception to the patient, to verifying eligibility, to collecting relevant co-pays before the visit, all of these matter in terms of patient engagement, better collection percentage, reduced collection cost and over- all profitability of the practice. So, you need to have a clearly defined workflow for the front desk. Make sure you are collecting prior balances before giving new service to the patient. Periodic retraining of the front desk employees is highly suggested. It is really important that these employees are well versed with your scheduling and EMR systems, as they are the ones who also trigger off your billing process.

A loose front desk operation on the other side can result in loosing patients, increasing bad debt, loosing revenue and increased cost of collections. Fine tune your front desk operations and you are guaranteed to have 5-15% additional revenue.

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Area#2 Stay On Top Of Your Insurance Contracts

Not being contracted means low patient volume, not being contracted for the right fee, means lost revenue, clearly neither is advisable. Look forward to contract with every noteworthy player in your market but while doing so make sure that you are negotiating a fair contract, that takes care of the full scope of service delivered.

If you have been contracted with a payer for a couple of years, review your reimbursement to make sure the contract still makes financial sense, if you think there is a need to renegotiate, start the process early as the insurance will take their own time in negotiations. However, if you are trying to negotiate a new payer contract, it is important that you present a good case for yourself. The insurance company always wants to keep their costs down and you can help them do so, but you need to show them the benefit of the benefit.

Equally important is to make sure you enforce the payer contracts while you receive payments. If you do not pay attention at the time of posting payments, you can lose a lot of money due to underpaid or incorrectly denied claims.

Area#3 Incomplete Documentation By Physicians

Even if you have a great EMR system installed, as a physician you need to truly understand how to work with the system. You provide great medical care to your patient; however, you need to be equally diligent in documenting the full scope of your service for your coders to pick up the chart and ensure the right service levels are coded and sent to the insurance to consider.  Not documenting in the right areas or incomplete documentation of the exam, ROS etc can mean a lower level of E&M code being billed and the difference in reimbursement for a lower level of E&M and a higher level can easily be $35-65 per instance.

Providers are trained in providing medical care to their patient, they are however, not trained coders, so it is critical that there is regular communication between the physicians and the coders to make sure the documentation is up to the mark. Periodical training for the providers on how to effectively use the EMR system is also very important. Your billing service provider should work closely with you in making sure you are being compliant and efficient both at the same time.

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Area#4 Prevent Charge Leakage

Missing out on charges is the last thing you want. It can cost you revenue and eat into your profit margins.

Often times the reason for charge leakage is incomplete documentation. Make sure that you take time to completely document every service provided. Most commonly missed charges are X-rays, interpretation, labs, DME, Gait training, injections etc. These are all payable services and every time you fail to document one of these, you are leaving money on the table.

It is also critical that you billing service has a charge reconciliation process in place to ensure they are billing out every charge. Similarly, it is also equally important to pay attention to how the additional services (apart from E&M) are being paid by the payers. Some payers pay so minimal for medicines that you may actually be paying more to procure the medicines than what is being reimbursed to you. Periodically reviewing your charges for payments is highly advisable. Your billing service should be able to provide you with this analysis and relevant reporting.


Try streamlining these four areas of your revenue cycle operations and see how your revenue can go up by 20-30%. Cosentus provides medical billing, coding and full suite practice management services to the urgent care clinics across United States and we are happy to take a look at your current processes to find areas of improvement and help determine, how you can maximize revenue for your clinic.

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