Poor Financial Performance in Your Urgent Care Pt. 3

Poor Financial Performance in Your Urgent Care Pt. 3

Last week, we learned how our reimbursement systems affect our practice's financial performance. This week, we’re going to take a long, hard look at our billing and collections process.

Billing and Collections

A second key area of importance involves the processes used for billing and collections. Physicians/owners should think of this area as being akin to an assembly line that begins with patient registration and continues through insurance verification and eligibility, over-the-counter collections of copayments and deductibles, charge entry, initial billing and follow-up, electronic claims submission, payment posting, self-pay account management, claims denial monitoring and management, and adherence to prompt-payment laws.

Clearly, these processes are critical for an Urgent Care facility seeking to generate and maintain consistent cash flow. To shorten the time from bill to payment, an organization may want to send payment notices to patients and copies to the third-party insurer. The notices should tell the patients that the insurance company has not responded, and the claim may be billed to the patient if there is no response. A good Office Manager will attempt to contact the insurer’s provider representative when payments are slow. When these efforts fail, however, the Urgent Care facility should report the problem to state’s Insurance Commissioner’s Office.

An Urgent Care centers cash flow will require daily reconciliation of charges and cash receipts through various activity reports. Tools such as online eligibility verification systems and claims scrubbers will help to improve the effectiveness of billing and collection systems, but a key component of the software system is that it must be able to deliver accurate reports that can be obtained dynamically.  Balancing your day, your month, and your year are necessary to validate that you are covering your costs.  Analyzing your cost to deliver services based on each Managed Care plan will enable you to decide on who you will need to renegotiate with and who you will potentially want to not renegotiate with.