27,410 visits
44,396 charge lines
About $245 charged and $138 paid per visit.
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Case study · Urgent care, 20-month book, measured
Urgent care billing: half the cash is the patient, and the gross rate is a contract, not a leak
A two-site, 14-provider urgent care group's complete line-level ledger, October 2024 to May 2026. We billed it throughout, so there is no before-and-after: 20 months of real urgent-care economics.
Short answer: patients paid $1.85M of $3.77M (49.1 percent). A 56.3 percent gross collection rate was the S9083 contract doing what it says, with about 100 percent net realization. The finding was $642K of credit balances, 1.3 times the open AR.
27,410 visits · 44,396 lines
S9083 · global fee
42 CFR 401.305 · 60 days
Achieved: measured after ASP took the work
Edition
Oct 2026
Archetype
2-site, 14-provider UC
Horizon
Oct 2024 to May 2026
Metric
49.1% patient cash
Payers
S9083 global
Length
6 min read
49.1%
of all cash came from patients, $1.85M of $3.77M over 20 months
56.3%
gross collection rate, with about 100 percent net realization on matured quarters
$642K
credit balances at May 31, 2026, 1.3 times the $480K open AR
35.0%
of open AR older than 90 days; 34.6 percent of open AR a patient balance
Where $6.70M of charges went, October 2024 to May 2026
A two-site, 14-provider group in a Midwestern metro, billed by us since 2024 and grown 15 to 20 percent over the period.
Charges to cash, contractual and open AR
Most commercial contracts pay the global fee S9083 instead of the itemized visit: hence a 46.1 percent write-down and a 56.3 percent gross rate. The S9083-or-per-visit map explains the contract logic.
Cash collected20 months
$3.77M56.3% of charges
Contractual write-downS9083 case rate
$3.09M46.1% of charges
Open AR at May 31, 20263,505 claims
$480K7.2% of charges
025%50%75%100% of charges
CashContract and receivableSource: ASP-RCM engagement records
Ramp, maturity, ledger cut
- 1Oct 2024Ledger starts; first quarter is a ramp, cohort gross collection 49 percent
- 22025Cohort gross collection rises through the year; matured quarters reach about 100 percent net realization. The 44-point gross-to-net gap is the S9083 case rate doing what the contract says.
- 3May 2026Ledger cut: $480K open AR, $642K credit balances
- 4Jun 2026Credentialing review of the same group, published separately
Cash by source, and the receivable against the credit ledger
Cash by source over 20 months
A front-desk sport: the counter collects as much as every insurer combined
$1.85MPatients49.1%
$1.92MInsurance50.9%
Open AR versus credit balances, May 31, 2026
The ratio, not the gross rate, was the finding
$480KOpen AR3,505 claims, 100%
$642KCredit balances134% of open AR
Takeaway
$1.85M of $3.77M came from patients. A one-point improvement at check-in is worth more here than a one-point improvement with any single payer.
Payers, codes and the per-visit arithmetic
One Blue plan, 45% of charges
Concentration
One renewal moves nearly half of the gross line and the book's net realization with it.
Most-billed codes
99204 · 99214 · 87428 · S9083
E/M levels, the COVID and flu combination test, the global fee.
~$1.49M by card
Front-desk cash
Card-on-file and statement timing are AR policy, not courtesy: 34.6 percent of open AR is owed by patients.
Good faith estimate
No Surprises Act
Required for uninsured and self-pay patients when care is scheduled three or more business days ahead [2].
60 days to return
42 CFR 401.305
Identified Medicare overpayments are reported and returned within 60 days [3]; a credit ledger this size is a compliance queue.
Receivable at May 31, 2026, and how to read it
| Measure | Value | Read |
|---|---|---|
| Open AR | $480K on 3,505 claims | Small relative to $6.70M charges |
| Days in AR | 43.5 | Within range for a global-fee book |
| AR over 90 days | 35.0% | Driven by patient balances |
| AR over 120 days | 23.8% | Statement cycle, not payer denials |
| Patient share of open AR | 34.6% | Front-desk and statement policy |
| Credit balances | $642K, 1.3x open AR | Overpayments until proven otherwise; refund and posting review |
The urgent-care operating pattern on this book
StepRuleWhy
Billing method locked per payerStep 1
RuleGlobal S9083 or itemized E/M, decided by contract
WhyWritten to the payer profile, never chosen at the visit
Front-desk collection as a KPIStep 2
RulePatient cash and card share as their own lines
Why49.1 percent of cash here
Cohort reporting, gross and netStep 3
RuleEvery quarter reported twice
WhyGross = contract view; net = leakage view
Patient AR on a statement clockStep 4
RuleBalances aged from first statement, not date of service
Why90-plus then shows statement cadence, not payer behavior
Credit-balance queueStep 5
RuleEvery credit worked to refund, offset or posting correction
WhyThe 60-day Medicare clock is tracked [3]
Concentration watchStep 6
RuleThe Blue plan at 45 percent of charges is one renewal risk
WhyReviewed monthly
A measured steady state, not an improvement claim
- B/ANo before-and-afterWe billed this book for all 20 months. The figures are a measured steady state.
- 835No denial-rate or clean-claim seriesThe ledger carries charges, payments and adjustments, not remittance reason codes, so we do not report a denial rate for this group.
- $Credit-balance resolutionThe $642K credit ledger is being worked to refund, offset or correction; the resolved total is not yet measured.
- 1One clientOne group's economics. Urgent care books with itemized contracts will show a different gross rate for the same net realization.
Status at October 27, 2026
Frequently asked questions
Why is a 56.3 percent gross collection rate not a problem here?
Because 46.1 percent of charges are contractual write-down under the payers' global-fee urgent care contracts, where S9083 replaces the itemized visit at a fixed case rate. On matured quarters the group collected effectively all of its net-allowed amount, about 100 percent net realization. The gross rate measures the contract discount, not leakage.
How much of urgent-care cash really comes from the patient?
In this book, 49.1 percent: $1.85M of $3.77M across 27,410 visits, and roughly $1.49M of all cash arrived by card. The front desk is a collection point on the same scale as every insurer combined.
What was the problem the ledger did surface?
Credit balances of $642K against $480K of open AR, 1.3 times the receivable. Patient and payer overpayments had been posted but not resolved. For Medicare, 42 CFR 401.305 requires an identified overpayment to be reported and returned within 60 days of identification, so unreviewed credits are a compliance item as well as a hygiene one.
Is there a before-and-after result?
No. ASP billed this book for the whole 20 months, so the figures are a measured steady state, not a turnaround. We also do not have a denial-rate or clean-claim series for this group, and we say so rather than estimate one.
- CMS: Healthcare Common Procedure Coding System (HCPCS) Level II
- CMS No Surprises: good faith estimates for uninsured and self-pay patients
- 42 CFR 401.305: Requirements for reporting and returning of overpayments (govinfo)
Checked October 27, 2026. Rules change; confirm against the source before relying on them. Client figures are archetype aggregates from ASP-RCM engagement records; no client is named.
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See your urgent care's cash by source, not just by payer
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