Urgent Care RCM Case Study: A/R Days Cut from 220 to 49

How Lister Reduced A/R Days from 220 to 49 and Increased Revenue per Patient by 198%

Client Overview

A U.S.-based Urgent Care and Primary Care Medical Center partnered with Lister to address growing revenue cycle challenges that were impacting collections, cash flow, and operational efficiency. At the time of engagement, the center faced excessive AR days, a large volume of outstanding receivables, low revenue per patient, and delayed claim resolution. Historical claims remained unresolved, denials were not being worked consistently, and unpaid accounts lacked structured follow-up. Lister was engaged to provide end-to-end Revenue Cycle Management (RCM) services and restore financial stability through disciplined billing execution and proactive AR management.

Key Challenges

#1 Long AR Days

The center had a significant volume of aging receivables, delaying eimbursement and limiting cash flow.

#2 High Closing AR

Outstanding balances continued to accumulate, resulting in a large AR backlog and reduced visibility into collectible revenue.

#3 Low Revenue Per Patient

Collections per patient encounter were below expected levels, indicating missed reimbursement opportunities and ineffective claim resolution processes.

Root Cause Analysis

Following a detailed review of the billing operation, Lister identified several underlying issues contributing to poor revenue cycle performance:

Denials were not being addressed consistently or within payer timelines.
Unpaid and no-response claims were not actively worked.
Historical claims remained unresolved for extended periods.
Delays in provider documentation and DOS approvals slowed claim submission.
Billing workflows lacked accountability and follow-up mechanisms.
E&M services were being billed using unusually high charge amounts, creating inflated AR balances and excessive contractual adjustments.
These issues collectively contributed to delayed collections, rising AR, and reduced financial performance.

Lister's Solution

Lister assumed responsibility for the center’s complete billing operation effective April 1, 2024. The resulting surge created:

End-to-end medical billing management
Historical claims recovery (2023 through 2024)
Denial management and appeals
AR follow-up and collections recovery
Charge entry and claim submission optimization
Documentation and DOS approval coordination
Revenue enhancement and billing process improvements

Process Improvements Implemented

1. Proactive Denial Management

Lister immediately began reviewing previously missed denials and implemented structured denial workflows to ensure claims were corrected and resubmitted within payer filing limits.

This prevented revenue leakage and improved reimbursement recovery rates.

2. Aggressive AR Follow-Up

Unpaid and no-response accounts were systematically reviewed and worked through a dedicated AR follow-up process.

Actions included:

Payer follow-up on aging claims
Resolution of stalled accounts
Claim corrections and resubmissions
Escalation of unresolved claims when necessary

This initiative played a critical role in reducing AR balances and accelerating collections.

3. Faster Charge Processing and Claim Submission

One of the key operational challenges was delayed DOS approvals and incomplete documentation.

Lister established a structured communication process with the center to identify pending charts, unsigned encounters, and missing information.

Once DOS approvals were received from the center, Lister consistently processed charges within 2 to 3 business days, significantly improving claim submission turnaround times and helping the center remain within payer filing requirements.

4. Standardization of E&M Billed Amounts

During the review process, Lister identified that the center’s billing to Evaluation & Management (E&M) services was in excess.

Although insurance carriers continued to reimburse according to their contracted fee schedules, the excessive billed amounts created two significant issues:

Large contractual adjustment amounts after payment posting
Inflated outstanding AR balances that did not accurately reflect collectible revenue

Lister's Recommendation

Lister recommended revising and standardizing E&M billed amounts to better align with reimbursement realities and industry best practices.

Outcome

Following implementation:

Contractual adjustment amounts were significantly reduced.
Outstanding AR became a more accurate representation of collectible receivables.
Financial reporting improved.
Inflated AR balances were eliminated, providing

better visibility into true revenue performance.

Results Achieved

AR Days Reduction

When Lister assumed billing operations in 2024:

• Initial AR Days: 220
• AR Days in 2026: 49

Impact

The center achieved a dramatic reduction in receivable aging, resulting in faster collections and stronger cash flow.

Closing AR Reduction

Impact

Through disciplined AR management and denial resolution, the center reduced outstanding receivables by 78.4%.

At the beginning of the engagement:

Closing AR: more than $1.5 Million. By 2026:
Closing AR Reduced by 78.4%

Key Outcomes Delivered by Lister

Reduced AR Days by 78.4%

From 220 AR days to just 49 days.

Reduced Closing AR by Over $1.3 Million

Increased Revenue Per Patient by 198%

Improved Charge Processing Efficiency Enhanced Financial Visibility Charges processed within 2–3 business days after DOS approval.

Standardized E&M billing reduced artificial AR inflation and excessive contractual adjustments. Strengthened Revenue Cycle Operations Established sustainable workflows for denials, AR follow-up, charge processing, and claims management.

Conclusion

When Lister assumed responsibility for the center's revenue cycle operations, the organization faced mounting AR, unresolved denials, delayed collections, and underperforming reimbursement metrics. Through proactive denial management, aggressive AR recovery efforts, streamlined charge processing, and strategic billing improvements, Lister helped transform the center’s financial performance. By mid 2026, AR days had fallen from 220 to 49, closing AR had decreased by more than $1.3 million, and revenue per patient had nearly tripled. The result was a healthier revenue cycle, improved cash flow, and a more scalable operational foundation for future growth.

Every practice deserves a revenue cycle that delivers predictable cash flow, timely reimbursements, and complete visibility into financial performance. Lister partners with urgent care, primary care, and family practice groups to improve every stage of the billing process—from charge capture and claim submission to denial management and collections. If your practice is struggling with high A/R, delayed payments, or declining reimbursement performance, we’ll help you build a healthier revenue cycle that supports long-term growth.

Why Healthcare Providers Choose Lister?

20+ years as Trusted RCM Partner.
5 M+ claims in Urgent Care, Primary Care & Family Practice.
98% First Pass Acceptance Rate.
<5% Initial Claim Denial Rate.
<10% Over 90 Days AR.
Working with one of the largest Urgent Care Brands in the US.
HIPAA Compliant & Secure processes.

Let's Find the Revenue You're Missing

Whether you’re looking to reduce aged A/R, improve reimbursement, recover unpaid claims, or strengthen your entire revenue cycle, our specialists are ready to help.

Complete the form below to schedule your complimentary Revenue Leakage Assessment (Worth $750) and discover practical opportunities to improve your financial performance.