Maximize revenue despite high uninsured volumes with real-time eligibility verification, automated insurance discovery, and critical care coding expertise.
Emergency and urgent care revenue cycle management (RCM) keeps critical care billing flowing from real-time eligibility verification and insurance discovery through accurate charge capture, claim submission, payment posting, and denial management—so unpredictable patient volumes and high uninsured rates don't turn into delayed reimbursements or write-offs.
Emergency departments and urgent care centers face a unique revenue challenge: unpredictable patient volumes, high percentages of uninsured or "unassigned" patients, and critical care coding that requires real-time documentation reconciliation. The fast-paced nature makes manual insurance verification impossible. IntegraRCM restores cash flow with automated insurance discovery, real-time eligibility verification (REV) at point of care, critical care coding expertise, and high-velocity claim workflows — proven to increase revenue by 30-50% and reduce denials by up to 85%.
The goal is simple but critical: verify coverage in real-time, code accurately for acuity, submit clean claims fast, and maintain cash flow despite volume volatility.
Emergency departments and urgent care centers use specialized clinical documentation systems. We adapt workflows to your platform, interfaces, and charge capture configuration, including:
Targets vary by patient mix, payer contracts, and system configuration. We baseline KPIs during onboarding and define SLAs to match your priorities.
Real-Time Eligibility & Insurance Discovery
Critical Care Documentation & Charge Capture
E&M Coding & Trauma Code Review
Pre-Submission Scrubbing & Claim Submission
Rapid Payment Posting & Reconciliation
High-Velocity Denial Work & A/R Follow-up
Speed + accuracy + insurance discovery = maximized emergency medicine revenue.
| Operational Area | Before IntegraRCM | After IntegraRCM |
|---|---|---|
| Insurance verification & discovery | Manual verification impossible at ED pace; many patients classified as self-pay incorrectly | Real-time eligibility verification + automated discovery uncovers hidden coverage, increases revenue 30-50% |
| Critical care & E&M coding accuracy | Generalist coders struggle with time-based billing and trauma code combinations | Emergency medicine coding specialists ensure proper E&M level justification and documentation support |
| Charge lag from documentation delays | Physicians document after shift; claims submitted days or weeks later | Same-day charge capture workflows and documentation reconciliation accelerate billing |
| Denial rate & rework volume | High denial rates from demographic errors, missing modifiers, and E&M downcoding | Pre-submission scrubbing and acuity-specific edits reduce denials by up to 85% |
| Cash flow predictability | Volume volatility and uninsured patients create unpredictable revenue | Consistent verification, coding excellence, and rapid follow-up stabilize collections |
Client: Multi-site emergency medicine group serving 3 hospital EDs with 85,000 annual patient encounters
Integrated at every patient encounter with ED registration workflow.
Searches multiple payer databases using patient demographics to uncover hidden coverage.
Reviewed all critical care claims for time documentation and E&M level justification.
With physician documentation reconciliation within 24 hours.
Emergency-specific edit rules for medical necessity and modifier usage.
Note: Results vary by patient demographics, payer mix, and system configuration. We baseline KPIs during onboarding and report progress against SLAs.
| Model | Description | Best For |
|---|---|---|
| Performance-Based (% of Collections) | Fee based on monthly collections (typically 4-8%), aligning incentives for maximum revenue recovery | Emergency medicine groups, urgent care centers with variable volumes |
| Per-Encounter Model / FTE Model | Fixed fee per patient encounter with full RCM service including verification, coding, and follow-up | Single-site urgent care centers, freestanding EDs with consistent patient flow |
| Hybrid Support Model | Base retainer for core services + variable fees for overflow, credentialing, and special projects | Hospital-employed ED groups, facilities with seasonal volume spikes |
Each engagement begins with onboarding: baseline KPI audit (self-pay rate, denial mix, charge lag), workflow mapping, REV integration setup, and SLA definition.
Most emergency groups see early impact within 30-45 days through insurance discovery and verification improvements, with sustained gains as coding accuracy and denial prevention mature.
Emergency and Urgent Care revenue cycle management (RCM) is the coordinated process of real-time eligibility verification, automated insurance discovery, charge capture for critical care services, claim submission, payment posting, denial management, and A/R follow-up designed to maximize reimbursement despite high volumes of uninsured and underinsured patients.
Real-time eligibility verification (REV) at the point of care can increase revenue by 30% to 50% and reduce denials by up to 85% by identifying valid insurance coverage before treatment, preventing uninsured denials, and enabling upfront collection of patient responsibility. This is critical in emergency settings where patients often arrive without insurance cards.
Yes. We align workflows to Epic (ED module), Cerner PowerChart, MEDITECH Expanse, T-System, NextGen, and other emergency medicine-specific platforms—adapting to your charge capture configuration, E&M coding requirements, and critical care documentation workflows.
Our emergency medicine coding specialists are trained specifically in E&M level justification, time-based billing documentation requirements, trauma code combinations, and critical care criteria. We review charts for proper acuity level assignment and ensure supporting documentation meets payer-specific requirements before claim submission.
We fully understand EMTALA requirements and design verification workflows that comply with federal mandates while maximizing revenue recovery. Our real-time eligibility and insurance discovery processes happen during or immediately after the medical screening exam, never delaying emergency treatment. We help you balance compliance obligations with financial performance.
Most emergency groups see early impact within 30-45 days through insurance discovery and verification improvements. Revenue recovery typically increases within the first billing cycle as previously "self-pay" patients are reclassified with discovered insurance coverage. Sustained gains in coding accuracy and denial prevention compound over subsequent months.
We'll review a sample of encounters, measure self-pay classification accuracy, evaluate insurance discovery opportunities, assess E&M coding patterns, and identify denial triggers—then provide a revenue recovery baseline with recommendations for verification, coding excellence, and denial prevention.
Assessment reports are typically delivered within 10 business days.