The urgent care industry has grown significantly over the past decade, providing an essential alternative to emergency rooms for non-life-threatening conditions. With a market value of $56.7 billion in 2022, it is projected to grow at a rate of 10.99% from 2023 to 2030.¹ However, with this growth comes the challenge of managing a complex revenue cycle. Understanding the revenue cycle management (RCM) process is crucial for your urgent care practice to optimize its operations, maximize revenue, and ensure financial health. 

5 Best Practices for Maximizing Revenue Cycle in Urgent Care

As urgent care centers grapple with escalating patient volumes and increasing operational costs, it becomes imperative to devise and implement effective strategies to streamline revenue cycle processes. This proactive approach is essential for ensuring precision in medical billing, optimizing collections, and bolstering overall cash flow, thereby safeguarding the financial stability of the centers while upholding their commitment to delivering superior patient care. Med USA’s best practices in urgent care include: 

1. Streamlined Patient Registration: Med USA leverages a custom EHR system with an intuitive online registration portal. Patients can complete pre-visit check-ins via mobile app or website, reducing front-desk bottlenecks and minimizing data entry errors. The system automatically populates patient information across billing and clinical platforms, saving your practice time by minimizing redundant paperwork.
2. Insurance Verification Automation: Med USA utilizes real-time insurance eligibility verification software integrated directly with major insurance networks. Before patient encounters, the system automatically checks coverage, copays, and potential out-of-pocket expenses, preventing unexpected billing issues and claim rejections–and avoiding complex and costly billing corrections.
3. Advanced Coding Precision: With a dedicated coding team of certified medical coders trained quarterly on the latest ICD-10 and CPT coding guidelines, Med USA uses advanced coding software to cross-reference diagnoses, procedures, and documentation to ensure maximum accuracy and compliance, safeguarding your practice from lost revenue due to delayed claims processing.
4. Comprehensive Billing Optimization: Med USA’s billing platform offers patients multiple payment channels, including online portals, mobile apps, text-to-pay options, and automated payment plans. Clear, transparent billing statements are generated immediately after services, with 24/7 customer support for billing inquiries, ensuring your practice is avoiding delayed payment and patient confusion.
5. Proactive Denial Management: Tracking denial rates in real-time using analytics dashboards, Med USA helps your practice stay on top of claims denials. A specialized appeals team investigates root causes, submits targeted appeals, and provides continuous training to prevent recurring issues. The goal: protecting your practice’s cash flow by maintaining a claim denial rate below 5%.

This isn’t just a technology upgrade; it’s a patient-centric approach that respects your time, protects patient information, and streamlines your practice’s entire healthcare experience. Embracing these strategies will improve your urgent care practice’s revenue cycles and position it for continued growth in a competitive healthcare landscape.

Critical RCM Metrics Your Urgent Care Practice Cannot Afford to Overlook

Tracking critical metrics for your urgent care RCM is essential. It allows your practice to monitor financial performance and identify areas for improvement, ultimately leading to enhanced efficiency and profitability. By closely tracking metrics such as average reimbursement time, denial rates, and collection ratios, your center can proactively address billing and collection issues, optimizing its revenue stream. This approach is crucial for early detection and resolution of financial issues. 

Tracking key metrics enables your practice to make data-driven decisions, allocate resources effectively, and adapt its strategies to changing market dynamics, fostering long-term sustainability and growth. Med USA tracks these key metrics regularly so your practice can focus on patient care:

• Days in Accounts Receivable (AR): With an average of 18 days to payment, Med USA maintains average days in AR significantly below the industry standard of 50-60 days. Their integrated billing system and proactive collections process enable rapid payment recovery, ensuring consistent cash flow.
• Claim Denial Rate: This percentage reflects the number of claims denied compared to the total number of claims submitted. A high denial rate may indicate incorrect information, lack of insurance verification, or coding problems within your billing office.²  By monitoring the percentage of denied claims by payers and exposing billing process issues, Med USA provides faster and more consistent reimbursement from insurance companies, leading to better financial health. 
• Net Collection Rate: This metric shows the percentage of total collectible revenue collected. A high net collection rate is more than just a number—it underscores the effectiveness of revenue cycle management and the importance of proactively managing your revenue cycle for success.³ Med USA consistently provides an average 18% increase in revenue collection.
• Patient Payment Collection Rate: Tracking how much patients pay at the point of service can help assess the effectiveness of payment policies and patient communication. Slower collection rates can significantly hinder your practice’s cash flow, potentially impacting vital operations and growth initiatives. Med USA collects patient payments through multiple payment channels, including mobile apps and online portals, reducing outstanding balances and improving cash flow.
• Cost to Collect: This metric examines the total cost of collecting payments compared to the revenue generated. Lowering these costs while maintaining efficiency is crucial for profitability. The cost of processing a large number of small claims and continuous follow-ups quickly accumulates and can outpace your practice’s financial performance. Med USA’s streamlined technological infrastructure and efficient billing processes minimize administrative overhead while maximizing revenue recovery.

The Benefits of Outsourcing Urgent Care RCM

Outsourcing RCM services to a partner specialized in urgent care billing brings a multitude of advantages. These include expert knowledge in urgent care, ensuring compliance and streamlined billing processes, enhanced efficiency leading to accelerated collections, and improved cash flow. Most importantly, it liberates urgent care providers from the administrative burden, allowing them to focus on what truly matters-patient care. It also provides access to cutting-edge technology and analytics for informed decision-making and scalability to manage growing patient volumes without compromising service quality. 

Staying ahead is vital for success. Med USA’s user-friendly RCM solution is specifically designed for this purpose. Our seamless integration with your practice’s systems reduces the need for manual interventions and offers scalable workflows tailored to your practice’s unique needs.

Urgent care centers are now focusing on overhauling their approach to revenue cycle management. At MedUSA, we’re here to support this transition with our proactive approach. Our billing solutions ensure financial success and bring peace of mind by proactively monitoring and rectifying any revenue cycle gaps, preventing issues before they arise. We aim to empower your urgent care practice to proactively address billing and collection issues, ultimately optimizing your revenue stream and ensuring financial success. MedUSA ensures optimal revenue recovery swiftly and empathetically, giving our clients peace of mind about their revenue and their patients. Interested in learning how MedUSA’s revenue cycle solutions can set your urgent care practice up for success? Schedule a discovery call.

Sources:

1. U.S. Urgent Care Centers Market Size, Share & Trends Analysis Report By Application (Acute Respiratory Infection, Injuries, Joint/Soft Tissue Issues), By Ownership, And Segment Forecasts, 2023 – 2030. Grand View Research. https://www.grandviewresearch.com/industry-analysis/us-urgent-care-market# 

2. (2023). Claims Denials and Appeals in ACA Marketplace Plans in 2021. KFF. https://www.kff.org/private-insurance/issue-brief/claims-denials-and-appeals-in-aca-marketplace-plans/#:~:text=We%20find%20that%2C%20across%20HealthCare,’

3. Important metrics for every physician practice – Net and Gross Collection Rate. Medical Billers and Coders. https://www.medicalbillersandcoders.com/blog/important-metrics-for-physician-practice-net-collection-rate-and-gross-collection-rate/