After enough revenue reviews, the pattern becomes obvious. The gap between a practice that collects 91% of what it’s owed and one that collects 98% is rarely about the EHR, the specialty, or even the payer mix. It’s about operating habits. Here’s what high-performing medical practices do that the rest don’t.
Urgent care practices that consistently achieve strong financial performance are not necessarily those with the highest patient volumes or most favorable payer mix. They are the ones that manage their revenue cycle with the same deliberateness they apply to clinical operations. Here is what they do differently.
1. They treat denials as data, not chores
Average practices rework denials one at a time and move on. High performers ask why and look for the pattern. They categorize every denial by reason and payer, find the upstream cause, and fix it so the same denial stops recurring. Since a large share of denials originate at the front end, that root-cause discipline pays off fast — and it’s how the best practices push their denial rate toward the sub-5% range while the national average climbs past 11%.
2. They watch the right scoreboard
They don’t celebrate gross charges. They track net collection rate against the 96–97% MGMA benchmark, days in A/R against the under-40 standard, and the share of A/R past 90 days. They know these numbers cold, this month, without asking anyone to “pull a report.”
3. They verify before the visit
High performers obsess over front-end accuracy — eligibility, demographics, authorization — because they understand that a denial prevented at registration is worth ten denials worked after the fact. Eligibility verification for every scheduled patient 48 to 72 hours before the appointment. Walk-in patients have a defined process that captures insurance information before the visit is complete. The cheapest claim to fix is the one that never gets denied.
4. They audit their payers
Not a single generic workflow applied to all payers. Workers’ Compensation cases follow state-specific billing requirements. Commercial plans with prior authorization lists are actively monitored for policy changes. Medicare documentation requirements are understood and applied consistently.
They don’t assume the posted payment is the correct payment. They compare against the contract, flag variances, and pursue underpayments. This single habit routinely surfaces revenue that average practices write off without ever noticing.
5. They appeal
When the data says a denial is wrong, they appeal it — systematically, not heroically. Given that the majority of appealed prior-authorization denials get overturned, the practices that appeal consistently simply collect more of what they’re owed than the practices that give up.
6. They give revenue an owner
This is the one that ties the others together. In high-performing practices, one person is unambiguously accountable for revenue performance end to end — not a shared inbox, not “the billing company,” not “whoever has time.” Ownership is what turns good intentions into consistent execution.
7. They have a partner who owns outcomes
Their revenue operations partner is measured by what the practice collects relative to what it is entitled to collect, not by claims submitted or tasks completed. This accountability structure changes behavior throughout the revenue cycle.
The takeaway
None of these habits requires new software or a bigger team. They require attention, discipline, and accountability — the same three things the average practice lets slip when everyone is busy. The good news: every one of them is learnable, and the payoff compounds.
Questions worth asking
- Of these six habits, which two would move your numbers the most — and are you doing them?
- Do you know your net collection rate and days in A/R right now, without pulling a report?
- Is there one person accountable for your revenue performance, or is it everyone’s job and therefore no one’s?
References:
- MGMA revenue cycle benchmarks — https://www.mgma.com/articles/finding-the-right-revenue-cycle-benchmarks
- AHA / Premier Inc. on overturned denials — https://www.aha.org/aha-center-health-innovation-market-scan/2024-04-02-payer-denial-tactics-how-confront-20-billion-problem