Recognize the Signs
Revenue cycle performance reflects what happens across the entire patient journey. Patient information, eligibility, clinical documentation, coding, charge capture, payer behavior, claims, and collections all influence how efficiently care becomes collected revenue.
Does This Sound Familiar?
Your billing team spends too much time fixing issues created earlier
Missing or inaccurate patient information, eligibility problems, incomplete documentation, coding issues, or missed charges create downstream rework before claims can move forward.
Claims appear resolved, but financial performance still feels off
A zero balance or closed claim does not always mean the organization received the reimbursement it expected.
You can see that a financial metric changed, but finding out why takes work
A/R, denials, collections, and reimbursement may signal a problem without showing which payer, provider, process, location, or stage of the patient journey is driving it.
Check Your Performance
Once you recognize that revenue performance may need attention, look beyond the final dollars collected. Start with measures that show how quickly and completely revenue moves through the cycle, then use a few targeted tests to uncover payer, claim, or upstream process issues those headline numbers may not explain.
Start With the Signals:
Days in A/R
Track: How long revenue remains in accounts receivable
HFMA defines net days in A/R as an industry-standard measure of overall revenue cycle efficiency. Its Revenue Cycle Score Calculator uses a 20–40 day range for physician practices and a 30–60 day range for hospitals when comparing performance with historical MAP Award applicants. (HFMA)
Use those ranges as broader healthcare context rather than urgent care-specific targets. Payer mix, services, patient responsibility, claim complexity, and other factors can influence the appropriate range.
What it can tell you: Whether revenue is moving through the cycle at the pace you expect
Interpret with: Time from visit to claim submission, payer mix, seasonality, write-offs, credits, and other factors that can change A/R performance
A/R Aging
Track: How much receivable remains unresolved as it gets older
HFMA’s Revenue Cycle Score Calculator uses 10%–25% billed A/R over 90 days for physician practices when comparing performance with historical MAP Award applicants. (HFMA)
The useful question is what is keeping those balances open.
What it can tell you: Whether older balances are accumulating
What to look for: Which payers, providers, locations, claim types, or unresolved issues account for a disproportionate share of aged A/R
Denial Rate
Track: How many claims are initially denied and what ultimately happens to them
HFMA’s MAP Keys identify remittance denial rate as a standard revenue cycle KPI and define it as the percentage of remitted claims containing an actionable denial. (HFMA)
For broader context, HFMA’s Revenue Cycle Score Calculator uses a 5%–7% denial-rate range for physician practices when comparing performance with historical MAP Award applicants. (HFMA)
The overall rate is only the beginning. HFMA’s claim-integrity guidance also recommends tracking denial dollars, time to appeal, time to resolution, and the percentage of initial denials overturned. (HFMA)
What it can tell you: Whether denials are creating a meaningful barrier to reimbursement
How to use it: Break denials down by payer, reason, provider, code, and final disposition, then trace recurring denial reasons back to the earliest point where they could have been prevented
Actual Versus Expected Reimbursement
Track: Whether claims are being paid at the amount you expected based on coding and payer contracts
A claim can reach a zero balance without being paid at the expected amount. Downcoding, underpayments, contractual adjustments, and other payment differences may never appear in a traditional denial report.
The potential variation is significant. A 2025 Journal of Urgent Care Medicine analysis of 17.4 million commercially insured urgent care visits found a national median net revenue per visit of $163.91, with state-level results ranging from $112.90 to $299.38.
What it can tell you: Whether closed claims are producing the reimbursement you expect
Compare by: Payer, E/M level, procedure, provider, and historical reimbursement to identify changes that aggregate revenue reporting may conceal
Time From Visit to Claim
Track: How long it takes a completed visit to become a submitted claim
This interval can help expose work occurring between care delivery and payer submission. Documentation completion, coding, charge capture, claim edits, and other pre-submission processes can all add time.
What it can tell you: Whether revenue is being delayed before the payer ever receives the claim
Look closer if: Completed visits regularly wait for documentation, coding, corrections, or other work before claims can be submitted
Payment Velocity
Track: How long payment takes after a claim is submitted
Pairing this measure with time from visit to claim helps separate two parts of the revenue cycle. One shows how efficiently the organization moves completed care into billing; the other shows what happens after the payer receives the claim.
What it can tell you: Whether payment is slowing after submission
Pair it with: Payer-level denials, requests for information, appeals, and reimbursement performance to understand what is delaying payment
A Good KPI Can Still Tell You the Wrong Story
Headline metrics tell you where to look. They do not always explain what happened.
A/R can improve because balances were collected or because they were written off. A claim can reach zero balance after full reimbursement or after an underpayment. A denial rate can decline while the dollars lost to final denials increase.
Use the top-level number as a starting point, then break it down by:
Payer | Provider | Location | Claim Type | Dollars | Final Disposition
And when a problem appears downstream, trace it backward. A denial, delayed claim, or underpayment may have roots in registration, eligibility, clinical documentation, charge capture, or coding.
Put It to the Test
Your revenue cycle metrics can show where performance deserves attention. These checks can help you get underneath the aggregate numbers and determine whether the issue begins before claim submission, with the payer, or later in the collection process.
Run the Five-Payer Revenue CheckStart with your five largest payers. For each one, compare: Average Reimbursement by E/M Level Now → Average Reimbursement by E/M Level Historically Then ask:
The goal is to identify reimbursement changes that organization-wide revenue reporting may conceal.
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Trace Five Denials Back to Their SourceChoose five recent denials representing one of your most common denial reasons. For each claim, trace the information backward through the patient journey: Denial → Claim → Coding/Charge Capture → Clinical Documentation → Eligibility/Registration Ask:
The goal is to distinguish denial management from denial prevention and identify problems that can be addressed closer to where they begin. |
Find Your A/R Black Hole
Pull your open A/R and identify claims with no meaningful activity since the last bill, rebill, payment, denial, status update, or appeal.
Sort them by:
Payer | Age | Balance | Location | Provider | Last Action
Then ask:
- Why is this claim still open?
- Who owns the next action?
- Is the delay internal or payer-driven?
- Are similar claims accumulating with the same payer or provider?
- How long has it been since meaningful action occurred?
- Is follow-up happening systematically or only when someone finds the claim?
The goal is to find balances that are aging without meaningful movement.
Interpret What You Find
What you uncover can point to very different revenue problems. Use the patterns below to determine where the issue is occurring and what deserves attention first.
Don’t Fix the Wrong Problem: A Healthy KPI Can Still Hide Revenue Leakage
A better number on the dashboard does not automatically mean more revenue was collected.
If old balances are written off, A/R can improve.
If an underpaid claim reaches zero balance, outstanding A/R can disappear.
If initial denials fall while the dollars lost to final denials increase, the headline rate can move in the right direction while the financial result moves the other way.
Before optimizing the metric, ask:
How was the balance actually resolved?
Where did the problem first enter the process?
How much work did resolution require?
Did we collect what we expected?
Time from visit to claim is increasing
Look upstream. Determine whether completed visits are waiting for documentation, coding, charge capture, corrections, or another pre-submission step. Focus on the first point where completed care stops moving toward a clean claim.
Days in A/R rise, but claims are still going out promptly
Move the investigation downstream. Review payer-level payment velocity, denials, requests for information, appeals, payer mix, credits, and write-offs to identify what changed.
The same denial reason appears repeatedly
Trace several examples back through the patient journey. If the same eligibility, registration, documentation, coding, or charge-capture issue appears repeatedly, focus on preventing it where the information is first created.
Claims reach zero balance, but reimbursement is declining
Compare actual reimbursement with expected reimbursement. Look for payer- or code-level patterns that could indicate underpayments, downcoding, contractual differences, or another source of lost revenue.
Medical-record requests increase
Identify which payers, providers, and codes are involved. Review whether documentation consistently supports the services billed and whether particular coding patterns are drawing disproportionate payer scrutiny.
One payer requires substantially more staff touches
Treat payer performance separately. Compare denials, requests for information, payment velocity, appeal activity, reimbursement, and manual work required to resolve claims.
A/R is aging without meaningful activity
Look at ownership and follow-up processes. Determine whether claims are waiting for internal action, payer action, documentation, an appeal, or another dependency and whether the organization has a reliable way to surface them.
Denial rate looks reasonable, but revenue is still being lost
Look beyond initial denials. Review denial dollars, final write-offs, appeal outcomes, underpayments, and expected versus actual reimbursement. HFMA similarly recommends measuring denial outcomes beyond the initial denial rate, including denial write-offs and overturned denials. (HFMA)
See What’s Possible
Revenue cycle improvement becomes more meaningful when it prevents avoidable rework, reduces manual intervention, and produces measurable financial results. These Exdion Health customer examples show what improvement can look like in large, multi-site urgent care organizations.
From 85% to 99% Straight-Through Processing
Fast Pace Health increased straight-through processing from 85% to 99% and sustained 99% performance for more than a year while supporting revenue cycle operations across approximately 250 clinics and 175,000 to 190,000 patient encounters each month.
What it shows: Fast Pace’s results demonstrate how reducing manual intervention can help a large urgent care organization manage substantial claim volume while maintaining coding quality.
More Than $224,000 in Seven Months
Patient Plus Urgent Care reported more than $224,000 in financial impact over seven months after implementing Exdion’s AI-powered coding technology, with monthly impact reaching as high as $57,466. The organization operates 11 clinics and serves more than 120,000 patients annually. (Exdion Health)
What it shows: Patient Plus’s results demonstrate how improving coding accuracy and efficiency can translate into measurable financial impact across a multi-site urgent care organization.
Connect the ProblemRevenue performance begins as soon as information enters the operation. Registration and eligibility establish the patient and payer information needed downstream. Clinical documentation records the care delivered. Practice-management processes help move charges, coding information, claims, and payments through the revenue cycle. Downstream RCM processes then determine how efficiently reimbursement is pursued, resolved, and collected. Connecting those processes can help prevent information from being lost or corrected repeatedly as it moves from the patient encounter to the final payment. It also gives leaders greater visibility into where revenue is slowing down and why. One Connected Platform for Urgent CareThe Experity Urgent Care Platform connects Patient Engagement, Patient Care, and Revenue Cycle capabilities around the urgent care journey, including the clinical and practice-management processes that help turn a completed visit into an accurate claim and collected revenue. Ready to see how Experity can help? |
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Keep Working on Your Operation
Revenue performance is influenced by information and processes that begin well before billing. Choose another challenge to investigate another part of the operation that can affect financial performance.
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