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.
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:
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.
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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.
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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:
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:
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.
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