Poor Financial Performance In Your Urgent Care – Part 1

If you have poor financial performance, then it could be due to your inattentive practices concerning your organization’s revenue cycle management process.  Coding, EMR and PM software systems flaws, reimbursement methodologies, billing and collection processes, all have an adverse effect on your organization’s overall accounts receivable health. Since many urgent care center physicians/owners are not aware of this problem, they often cannot “stop the bleeding†prior to disaster striking. When there is a lack of appropriate oversight in your accounts receivable process, coupled with declines in income from other factors, it can mean the difference in your organization staying open or closing.  Industry experts all agree that physicians/owners who manage revenue processes diligently will see improvements in financial performance.

Over the past few years, the explosion of urgent care centers across the United States have led both directly and indirectly to shrinking market share, which has resulted in declining cash flows, inability to negotiate favorable contracts with managed care plans, reduced patient volume, and an increase in client demands often resulting in increased employee turnover and higher payer scrutiny of claims because of mistakes which results in delays of payments by almost all third-party payers.

Although most urgent care owners/operators are now beginning to understand the increased complexity of reimbursement regulations require a different level of expertise among physicians and office staff members, finding the money to support those efforts, as well as locate the talent, is often the reason an organization has poor financial performance.

In the past few years, the industry states that physicians/owners are spending more time and money on oversight control in areas such as medical practice and coding compliance, EMR set-up and template development, charge validation studies, utilization and referral management, and even follow-up on denied claims.  Oftentimes physicians/owners are feeling overwhelmed and frustrated which results in their inability to practice medicine. While they can do little about these factors except apply the necessary management expertise, there are other areas of revenue cycle management that can help an organization’s bottom line when properly managed.

Signs of Weakness

If revenue cycle management is weak, physicians/owners will see the following symptoms:

  • Aged accounts receivable reports not being managed consistently
  • Decreased number of telephone calls being placed to delinquent payers
  • Many duplicate claim rejections
  • Secondary payers not being billed promptly, or payment denials not being followed
  • Rising numbers of unanswered letters or other communications from payers seeking more information
  • Failure to monitor over the counter collections

Just like any other type of medical practice, there are only five key areas to address when seeking to improve financial performance:

  1. Reimbursement systems
  2. Billing and collection processes
  3. Accounts receivable management
  4. Operations improvement
  5. Practice growth

If your organization needs assistance with understanding your Financial Performance, contact us.

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