A Detailed Guide to Deal Practice’s Urgent Care Billing & Coding

urgent care billing
urgent care billing

As a practitioner, your practice thrives as long as you have enough patients to take care of them and you are responsible for all aspects of revenue cycle management. If you make mistakes with your urgent care billing, your facility will lose more than just a few dollars. They may be highly costly, sometimes even compromising your center’s success.

In addition, despite your hard work and hiring more professionals to help with the added workload of providing healthcare. Your profit margin is still not where you had expected it to be. The financial leakage in your billing for urgent care and primary care operations may be the reason for this. Here’s how you may increase your profit margin with a basic understanding of urgent care billing.

The process of urgent care billing

In 2003, the Centers for Medicare and Medicaid Services (CMS) designated POS – 20 (a place of service-20), commonly known as an Urgent Care Facility. The venue, according to CMS, is “a site different from a hospital emergency room, an office, or a clinic, whose purpose is to diagnose and treat disease or injury for unplanned, ambulatory individuals requiring immediate medical assistance.”

Insurance companies and nearly all associated payers must follow CMS rules. However, when the contract language is missing, the urgent care center must use the POS-20.

Moreover, urgent care facilities can create a contract or bill as POS-11 (Used for services obtained at a doctor’s office). However, they can only use POS-11 if the operating conditions of the healthcare industry allow it.

Urgent Care Billing
Urgent Care Billing

The urgent care clinic in healthcare systems efficiently fills the gap between the delivery of primary care by the affiliated provider and the emergency department facility at a hospital. This is why its popularity has skyrocketed in recent years. It also anticipates that the value of Urgent Care Medical Billing will exceed $26 billion by the end of 2023.

Controlling billing procedures as a medical practitioner allows you to boost and optimize workflow for optimal profits.

Urgent Care Billing Begins at Your Front Desk.

A critical cycle that begins at the front desk is urgent care billing, much like revenue cycle management. You would have a better chance of increasing your revenue and protecting your profit from revenue leakage. Mainly caused by the collection procedure, which is expensive if you create effective and efficient financial rules that start with the first visit.

There is no such system of pre-visit appointments in urgent care centers. Instead, patients can receive medical treatment immediately. In contrast, a patient seeking a walk-in appointment must give some basic information at the front desk. That’s what we call a registration procedure. These details might consist of;

  • Demographic data about the patient, such as an address, name, birth date, and medical issue, would be the reason for the visit.
  • Information about the insurance company, including the name of the primary insurer and the policy number.

The data gathered at the front desk aided the registration process and made it easier to maintain electronic health records EHRs. A patient’s medical history and other data are kept in an electronic database known as an EHR. Following the patient’s admission to the urgent care facility, the healthcare practitioner and staff work to update the EHR with all relevant information, including notes, prescriptions, proposed treatments, health conditions, and suggestions for procedures from the doctor.

An efficient EHR with complete and updated information makes the urgent care billing services process much easier. The information gathered at the front desk is crucial to determine if a patient has previously visited or is a repeat visitor. The front desk’s information is vital for each visit for this purpose.

Information on financial accountability

The staff at an urgent care center is too busy creating patient plans. They are not accessible to validate the health insurance policies that clients mention at the front desk. Hospitals and private practices often oversee this pre-authorization service.

For this, patients must have full knowledge of their insurance policies, including whether they are covered for walk-in or emergency medical appointments.

Patients must sign an affidavit agreeing to assume financial responsibility before receiving medical treatment due to the staff’s excessive workload.

Reaching Patients Twice Following Medical Visits

Every medical facility’s front office must update, record, and contribute the relevant data to the EHR, regardless of where the patient received their medical care. The information entered into the EHR makes it easier to create correct billing, submit claims, and get money back from patient insurers.

Urgent Care Billing
Urgent Care Billing

Transmission Of Claims

All medical processes are carefully reviewed to ensure compliance with necessary federal or CMS criteria once finished, and all provided treatments are coded.

The submission of the urgent care billing claims to the insurance company follows this as the last stage of the procedure. The insurance company’s claim or bill contains all the details of the treatment that a patient has insured from a certain hospital or physician. The claim also contains details about the surgery, diagnosis, and related costs. Providers will receive full reimbursement if their claims are accurate, error-free, and compliant with all rules.

Commonly Used CPT Codes for Urgent Care Billing

Typically, urgent care clinics only bill for Category I codes. This includes the less sophisticated 99213 and 99214, utilized in the emergency room. These two CPT codes do not normally reimburse as much as the other categories since they are less frequent. For a new patient service that calls for a thorough medical history and examination as well as somewhat difficult medical decision-making, the most often used code among them is 99204. As a result, this code has a fair amount of compensation and little chance of non-compliance.

While Urgent Care CPT codes are intended for visits connected to emergencies, they can also be used for regular doctor’s office visits. The primary distinction between the two is that the first code is used for walk-in patients and the second for appointments. It is possible to bill CPT S9088 for a walk-in patient. However, Medicare and Medicaid insurance do not accept this code.

It is not free to utilize CPT codes since the AMA controls them. Furthermore, CPT code explanations are not available online or for download. Additionally, the CPT code search tool, which is exclusively accessible to registered users, requires registration. Despite the expense, getting a list of the CPT codes that urgent care centers use and using them to submit claims for your services is simple.

Ensure Accurate Prior Authorization for Urgent Care Billing 

Billing for urgent care involves the capacity to bill more than a primary care facility and prior authorization. Urgent care centers may use higher S codes to reflect the more significant costs incurred after hours. However, since CMS might not pay Urgent Care for certain treatments, billing discrepancies and problems with prior authorization can delay reimbursement. To reduce misunderstandings, urgent care staff members should be knowledgeable about proper billing and coding procedures.

Even though the coding rules for general and urgent care billing are comparable, they frequently differ. An urgent care coder must follow insurance provider guidelines and assess whether codes are appropriate for specific medical procedures. The claim will most likely be denied if an urgent care practitioner does not seek the patient’s insurance pre-authorization before billing for services. Furthermore, most Urgent Care practitioners do not have time to call insurance companies to verify coverage. A denial without prior authorization might significantly reduce a clinic’s revenue.

How does NEO MD handle Urgent Care billing for practices?

You may grow your practice with the help of our professional team of medical coders and billers. Our team follows all Medicare Urgent Care Billing and Coding guidelines to ensure the greatest possible reimbursement. Real-time, accurate, quick, and error-free coding of each claim, along with an early review to assure claim eligibility, decreases the chance of claim denial. Many freshly built healthcare facilities are managed by well-known revenue cycle management companies in the United States. Most healthcare organizations are likely to accept only a few medical billing companies.

NEO MD Medical Billing has worked with several urgent care facilities across the country. With over 15 years of expertise in billing for outpatient clinics and emergency rooms, we have pioneered solutions transforming the revenue cycle management industry.

NEO MD also provides medical billing services for small practices, medium size, and large clinics. In addition, we provide customized billing services to medical practitioners in all 50 states. Therefore, the healthcare facilities locate us with the best Medical Billing company near me to acquire assistance.

What Makes NEO MD the Best Urgent Care Services Company?

NEO MD stood best among competitors in terms of providing good Revenue Cycle Management services to practices due to the following cores;

  • Our experts work hard to reduce your front-end denials by 20%.
  • Offer Provider & Staff Productivity Analysis
  • Use the latest technology and tools to ensure the accuracy of claims and faster collection.
  • Provide fortnightly financial and practice overviews 
  • Offer Services that are easily scalable at all times 
  • We have consistently increased the collection rate (Urgent Care Billing) for our clients
  • Offer internal Medical Billing audits to uncover loopholes
  • Refunds adjustment and Payment posting to improve the cash flow.
  • Out of Network Negotiations.
  • Identify potential under, over, and incorrect coding scenarios
  • Improve RCM system efficiency with a robust credentialing team. 

Let’s schedule an appointment and discuss it in-depth with Medical Billing and Coding specialists. Contact us now at (info@neomdinc.com) or (929) 502-3636).

Urgent Care Billing
Urgent Care Billing


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