4 Habits to Start Today for Improved RCM in Urgent Care

Effective revenue cycle management (RCM) is the backbone of any successful urgent care operation. In our experience at Experity — and as outlined by Experity’s former SVP of RCM Sales and Solutions, Ben Tischler — many clinics overlook simple yet critical RCM tasks that can significantly impact profitability. Using data from hundreds of RCM clients, Tishler explained patterns and trends in the webinar Hidden Revenue Cycle Mistakes that Hurt Most Urgent Cares.

Here are the top four habits clinics should adapt and tips to implement them at your own urgent care for immediate RCM improvement.

Month End Closing

We all know that you can’t manage what you don’t measure. Ninety five percent of businesses outside of healthcare do a formal month end close where they review their profit and loss. Yet, according to Tishler, around 60-75 percent of urgent care clinics perform complete month-end closes. This makes it difficult for those 35-40 percent of clinics to understand where improvements are needed and how to leverage what’s working well. Here is what Tishler recommends.

Action Steps:

1. Set a Closing Schedule: Establish a disciplined schedule for month-end closing and stick to it. Put it on your calendar to ensure it gets done.
2. Develop a Set of Reports: Create a standard set of reports to be generated every month, such as AR aging reports and CPT by provider reports. Review these with your management team. You can directly download our Metrics that Matter PDF here if you need help >>
3. Reconcile Cash: Ensure that your bank deposits match the amounts posted to your practice management system.
4. Send Patient Statements Regularly: Avoid sending all statements at once to prevent overwhelming your call center. Instead, send them out weekly.
5. Implement Online Bill Pay: Make it easy for patients to pay their bills online to reduce the volume of calls and improve cash flow.

Real Time Verification

Real Time Insurance Verification should be used for every patient every visit. But more importantly, your front desk staff needs to be trained on what to do with the results. For instance, if a verification check returns without insurance information, the front desk should be prepared to set up a payment plan or take a credit card payment immediately.

Action Steps:

1. Use Real-Time Verification Tools: Ensure you are using real-time verification and eligibility tools to check patient information for every visit.
2. Train Front Desk Staff: At the very least, educate your front desk staff on how to handle verification results. For even better RCM improvement, develop a checklist or SOP for all front desk tasks to help them avoid missing anything that would lead to a denial or rejection. We have a blog that covers best practices with a direct download to a Front Desk Checklist PDF to help you stay consistent.
3. Monitor and Adjust: Regularly review the effectiveness of your verification process and make adjustments as needed to improve accuracy and efficiency.

Accounts Receivable Follow-up

This is where a lot of clinics struggle to recoup payments, especially without a person on staff or outside partner exclusively dedicated to billing. This can get tricky because, in addition to being strapped for time and resources, the follow-up cadence is different for certain payers. For example, Medicare claims should be followed up every thirty days, while commercial payers might require a forty-five-day follow-up.

Action Steps:

1. Set Follow-Up Guidelines: Determine a follow-up cadence for each payer and establish a standard schedule.
2. Allocate Time for Follow-Up: Ensure that staff have dedicated time to perform follow-up tasks. This should be a regular part of their schedule.
3. Monitor Follow-Up Activities: Track follow-up activities to ensure they are being performed consistently. Look for detailed notes on claims that are over 120 days old.
4. Grade Your Performance: At the end of each month, review a sample of claims and grade your follow-up performance. Aim to improve your grade each month.

Coding Accuracy

Proper coding ensures that claims are submitted correctly, compliant with the latest standards, and reflect the true level of service provided. However, coding updates are released regularly, so the potential to over code (which is fraudulent) or under code (which equals loss of profit) can be high.

Action Steps:

1. Regular Audits and Training: Schedule frequent audits and continuous education sessions for your providers and coding staff. This ensures everyone is up to speed with the latest updates and best practices.
2. Standardize Coding Practices: Develop clear, standardized coding procedures that every provider must follow.
3. Document Risk Assessments: Accurate risk assessment in patient documentation directly influences coding quality. The more detail your providers capture, the better your coding aligns with current standards.

4. Leverage Technology: Use software tools that help monitor coding trends and flag discrepancies before claims are submitted.

Unlock Your Urgent Care Revenue

Every neglected RCM task—  from month-end closing and real-time insurance verification to diligent follow-up on accounts receivable and accurate coding — plays a crucial role in your clinic’s profitability. As Tishler’s insights show, even small improvements in these areas can translate to a significant lift in revenue, sometimes as high as 5-10 percent or more.

Experity’s free Performance Assessment is designed to help you identify exactly where these gaps lie. Our comprehensive review covers:

• Detailed analysis of your current RCM practices
• Identification of overlooked tasks and actionable recommendations for improvement
• Customized reporting that benchmarks your performance against industry standards

By taking advantage of our free Performance Assessment, you not only gain clarity on your current revenue cycle performance but also receive expert guidance to optimize processes, reduce denials, and enhance cash flow. Experity’s Performance Assessment is a significant step toward a more profitable and efficient urgent care operation. Click below to make a request.

Transform Your RCM Performance