Urgent Care Billing Optimization: How to Improve Your RCM

Most urgent care clinics have some weaknesses in their billing process. And right now, clinics are so strained that the impact of these weaknesses is exacerbated across the entire revenue cycle.

High visit volume is creating stress that not only bottlenecks the workflow, but also increases human error. On top of that, the rules around coding and documentation have changed for the first time in 25 years. Confusion is rampant, and staff is burning out left and right.

So how do you support your staff and protect your revenue?

We met with Experity experts Monte Sandler, Executive Vice President of Revenue Cycle Management, and Ben Tischler, Senior Vice President of Revenue Cycle Management Sales and Solutions, for insights on what to look at in your billing process to identify obstacles — and what you can do to optimize your rev cycle.

Standard operating procedures

One thing Sandler adamantly recommends is to develop standard operating procedures.  “SOPs are so foundationally important. Everything should be well defined and ensure there are checks and balances along with other standards that are followed for consistency.”

A defined process helps ensure that nothing falls through the cracks. It aligns everyone on best practices and other expectations to ensure that coding, charges, payment posting, and exceptions are handled timely and appropriately.

Let’s review how to break down your billing process and evaluate for improvements so you know what specifics to consider in your SOP.

Minimizing exceptions

As mentioned above, your SOP should detail how to handle exceptions in a timely manner because you’ll always have them. However, your standard practices should reduce the number of exceptions you have to work. Tischler states, “If something gets rejected or denied, it takes five times the effort to get it paid than if it went through cleanly.”

To reduce rejections, denials, and unpaid AR, you want to build a workflow that helps minimize exceptions. And a lot of this will center around the front of the house.

Front desk staff have the lowest paid positions in the clinic, the highest turnover, and yet the most important role in the revenue cycle. This first stage is where the most mistakes are made — collecting critical, accurate information from patients. And if something is missed here, everything will be wrong when it’s time to bill.

In fact, registration and eligibility errors are the single biggest reasons for exceptions. So let’s tackle how to manage that.

Electronic registration

Whether you allow patients to make an appointment, reserve a spot in line, or digitally check in, if they’re already doing pre-visit work online, give them the opportunity to register here, too. It not only improves accuracy (especially around personal details,) but also speeds up the entire pre-visit process for your staff.

Real-time verification

Real-time verification (RTV) or real-time eligibility (RTE) are powerful, fast tools that Sandler strongly endorses. This will help your staff make sure patients are eligible and that they get registered appropriately. But what’s important about using these tools is knowing what to do with the results you get. If the patient is not eligible to use insurance, staff should be trained on next steps to take, like setting up a payment plan.

Accuracy around patient information will help kick off the process successfully. But the front desk doesn’t bear all the weight of precision. Providers need to code correctly, and right now is probably the most difficult time in their careers to do so. Sandler states,

“The coding changed January one of 21, and they basically flipped the rules 180 degrees from the last 25 years. So we’re having to train all these providers about how they document and what they document to make sure they’re properly coding and billing for the services they’re rendering.”

Accurate coding guidance

Ongoing training should continually shape your SOP. Any source of truth that can be shared among providers can be included, along with appropriate checklists or anything else that helps keep providers current. It should also be someone’s responsibility to ensure these resources are up to date.

Need help with resources? You can get a COVID-19 coding cheat sheet from the November 2021 update here. We also have a coding resource hub and a COVID-19 resource hub.

Reduce days in AR

Submitting accurate claims and checking eligibility will help close the gap on getting paid. But you’re still left with copays and other fees that are the patients’ responsibility. Here are some tools and strategies that can help optimize this part of the revenue cycle.

Credit card on file

One of the quickest ways to resolve outstanding payments is to adopt a credit card on file program. Patients are already used to this paradigm with services like Amazon and Apple. Why not use it for urgent care? With the patient’s permission, you can charge their credit card with the amount that’s left over after the claim goes through. And it’s more convenient for the patient because it’s a step they don’t have to think about again.

Reduce paper statements and simplify payment

Having a credit card on file will take paper statements out of the equation, but what about patients who cannot provide a credit card? Not only does the clinic not want to suck resources sending paper statements that they cross their fingers patients will take care of, patients also don’t want to receive a stack of statements.

Sandler recommends a couple of best practices here:

• Text balance reminders. Even if they don’t give you a credit card, most patients can accept texts. By texting a balance reminder with a link to bill pay, the patient has the bill in hand and can simply click a link to either pay it or call the clinic’s billing number. If the text balance reminders aren’t successful, then send out the paper statement as a last resort.
• Utilize call center technology. When a patient does have to call in, there are several ways you can provide a better experience for them. For example, Interactive Voice Response (IVR) lets patients pay over the phone without having to talk to anyone. Call centers can also bifurcate tough calls from easy ones and route things appropriately so it’s a friendlier exchange for all.

Simplifying the payment process can also take place at the front desk, even when you didn’t automatically charge a balance to a credit card. Sometimes you have the opportunity to ask for outstanding payment when you ask for a copay.

Tischler pointed out that not everyone feels comfortable asking for money. So it’s wise to find the person who does, and then coach them on their script to make this request easier. For example:

“Hi, how are you – sorry you’re not feeling well. Ok Let’s see. You have a $25 dollar copay. Want to give me your credit card and I’ll take care of it? Oh! I see from the last time you were here, you owe $10. Is it OK if I just go ahead and put that on here as well?”

Other tips for optimizing your revenue cycle

As most of our other recommendations suggest, technology can make your life a whole lot easier. More importantly, they can improve your numbers by a lot. Take advantage of these tools! Here are a few other ways you can leverage automation in the rev cycle:

• EDI – Electronic Data Interchange allows payers and care providers to send and receive information faster, often at a lower cost.
• ERA – Electronic Remittance Advice is the electronic version of the explanation of benefits (EOB) for claims payments.
• EFT – Electronic Funds Transfer transmits funds for claims payments directly from a health plan into your bank account.

Train on technology

Of course, having technology does not always mean it is used correctly. In fact, with a robust solution like Experity, different people will use the same technology in different ways. Sandler compares this to using Microsoft Excel — some people use its advanced capabilities while others simply use its spreadsheet functionality. What’s important is to make sure your staff is aware of all the functionality that applies to them, and then train them to use it appropriately.

Advanced analytics & monthly scorecards

Sandler often finds that clinics have one person who knows how to pull reports out of the system, and that they may not review them as often as they should. Nor do they necessarily share that information. He recommends closing out month-end reporting and meeting to review financials every month. This is the best way to gauge where you’re at, where you need to improve, and what has succeeded the most.

Need help compiling metrics? Get the KPI cheat sheet >>

Final thoughts

When COVID-19 hit, most of us had to quickly pivot and even scramble to adjust — not only to a new set of rules, but also a tsunami of patient volume. And as average patient volume has actually gone up since then, the advice Sandler leaves us with is this:

“No matter how big or small your clinic is, building a revenue cycle for scale is critical.”

Yes, automation and technology will help you, but the pandemic has also changed the labor market. It has strained resources like few things before, especially for smaller, independent urgent cares. The ability to quickly add new talent just isn’t there for standalone clinics, and they’re not necessarily easy for franchises, either.

The best way to tackle this issue is through strategic partnerships. When you invest in services and technologies to improve your rev cycle, don’t just seek out vendors. Look for partnerships with established companies who understand your specific needs and who work to help you succeed. Partner with a company like Experity (that’s us!) who have access to a large pool of billing talent — so we can easily and quickly add needed resources in times of flux.

If it’s time to look for a new partner, check out our RCM page. Or sign up for a free billing analysis to see how we look at the revenue cycle and what advice we can give you to improve.

Not interested in talking to us right now? Take this billing self-evaluation and see how your best practices score against recommended practices.

TAKE THE BILLING SELF-EVALUATION