Billing is crucial in the success of an urgent care company, as it is one of the biggest contributors to the revenue of the business. However, due to the hectic nature of such facilities, the issue of billing is generally not without great difficulty. This is because managing a large number of patients and different payers demands coupled with constantly evolving coding systems results in many claims holding times and lost revenue. Through outsourcing to an experienced urgent care billing company, providers can offload these overheads for better financial outcomes.
Challenges of Urgent Care Billing Companies
Billing challenges are expected due to the fact that urgent care companies operate along the walk-in model because of the immediacy of the services that are offered. Due to open access services where patients can attend without prior appointments for minor injuries, acute illnesses, vaccinations, and occupational health services, documentation must accommodate very episodic patient needs within the same practice.
Because of many patients that visit the facility daily, billers are overwhelmed by the number of charts that need to be coded. The fast patient turnover also limits the front-end staff’s ability to obtain the detailed patient registration information that is required for the claims processing. Lack of information results in a high rejection rate and also delays in reimbursement.
Further, patients with some commercial and government health plans attended to in urgent care facilities. Every payer has its rules regarding the procedures that it covers and what it deems as necessary and its fee schedule. Sustaining an ever-evolving awareness of these regulations to ensure the accuracy of submitted claims is an enormous burden.
Common Mistakes to Avoid When Designing an Urgent Care
Medical coding cannot be done without formal training and education even if one has all the clinical details in front of him. CPT codes associated with urgent care services do not fall under the usual E/M service level codes for emergency department and clinic visits. If the wrong codes are selected, there are problems with increased workloads, and reimbursement issues take time.
Comprehensive ICD-10 diagnosis coding is crucial for substantiating medical necessity for reimbursement purposes, which is simple to manipulate in a fast-paced urgent care setting. Omission of code or error leads to auditable claims to the payer. Further, urgent care needs extra reporting methods to identify a face-to-face visit or a telehealth one. These are some of the most significant ways that modifier errors affect reimbursement rates.
Telehealth Billing Considerations
Telemedicine has become popular in most urgent care companies since it enhances access and convenience. But, as with all things, virtual care billing comes with its own set of telehealth, and payers to enroll for telehealth reimbursement. These variables are dynamic and will change often due to the dynamic nature of telehealth regulations that should be monitored closely.
Optimizing Payment with the Aid of Urgent Care Billing Professionals
Considering all these complicated and dynamic billing rules peculiar to urgent care billing companies, a vast number of providers rely on professional medical billing service providers. Offloading billing overhead enables inside staff to focus on providing quality health care services.
Skilled urgent care billing services have advanced billing tools and present time-payer policy information and how to deal with the claims with lots of professionalism. This helps avoid costly coding errors and maintain low rejection rates through auditing procedures.
The outsourced billers are tenacious negotiators while addressing the payer concerns and seeking appeals for every denied claim that is invalid to the urgent care practice revenues. They also include analytics and a KPI dashboard for revenue cycle performance to enable the identification of process fixes.
Providers can achieve higher and faster reimbursement and fewer administrative issues when they incorporate urgent care billing specialties and fewer administrative issues when they incorporate urgent care billing specialists as an extension of current teams. This enables the urgent care company to operate more efficiently, optimally and reinvest the surpluses towards improving on the quality of services offered.
Conclusion
There is always specialized medical billing, to remove barriers for the providers to capture patients’ care and financial goals to address center owners of urgent care who are frustrated with urgent care billing challenges. Partner with an experienced urgent care billing company as soon as possible to enjoy these advantages in revenue cycle management for yourself.