When cash deteriorates, the instinct is to push harder on collections. It is the wrong end. Most revenue leakage is created at registration, days earlier, by someone under time pressure who had no idea the keystroke mattered.
Emergency departments never condition care on coverage, so registration quality is often established after stabilization rather than at a before-service checkpoint — which makes it matter more, not less. The five metrics we run on: clean claim rate · denial rate segmented by reason · days in A/R · aged A/R over 90 days · net collection rate. Segmented by payer, monthly. The aggregate numbers tell you there is a problem; the segments tell you where.