Recovering Lost Revenue for an Urgent Care Center

Client Overview:

Our client is a busy urgent care center with a steady flow of patients. Despite the consistent patient volume, the center was experiencing significantly low revenue due to inaccurate billing and errors caused by the in-house billing team.

Challenge

The urgent care center faced multiple challenges:

evenue losses due to billing inaccuracies.
Poor claims follow-up practices.
Lack of proper auditing and appeals for denied claims.
Inadequate documentation and tracking of claims status.

As a result, monthly collections were alarmingly low despite the steady patient volume, severely impacting the center’s financial health.

Solution

To address the revenue recovery issue, we implemented a structured and strategic approach:

Data Analysis Using MGMA Benchmarks:

We started by creating an MGMA Benchmark (A/R) chart to identify revenue losses across different buckets. This provided a clear understanding of where revenue leaks were happening, enabling us to prioritize corrective measures effectively.

Prioritizing Claims:

Claims were categorized based on their dollar value and age of service. High-value and older claims were given immediate attention to maximize recovery in the shortest possible time. This ensured that the most critical revenue opportunities were addressed first.

Detailed Appeals and Corrected Claims:

After conducting thorough audits of chart notes, we identified and corrected errors in the claims. Comprehensive appeals were crafted, including all necessary supporting documentation. These appeals were then resubmitted to insurance providers, significantly increasing the chances of claim approval.

Regular Progress Tracking:

Detailed reports were maintained to track the progress of each claim, enabling transparent communication with the client and ongoing refinement of our approach.