Despite having a profitable urgent care business with a respectable patient volume, favorable online ratings. Staff members committed to offering compassionate, evidence-based care, your profit margins are still lower than you had anticipated. Your billing procedures may be the problem if your revenue falls short of expectations. Discover the fundamentals of urgent care billing and how making a few little changes can increase your practice’s earnings.
How Does the Billing Process for Urgent Care Work?
Urgent care clinics bridge the gap between primary care physicians and emergency rooms. Which is a critical function of these facilities in our healthcare system. They are anticipated to be valued $26 billion by 2023 and are projected to grow in popularity as a result. You must comprehend the fundamentals of billing and how to optimize your workflows for optimal profits if you want to command your fair piece of the market.
The Front Desk Is Where Billing for Urgent Care Begins
The loop of invoicing for urgent care starts at the front door. You may improve your revenue and spend less on pricey collection procedures by establishing sound financial regulations that start at check-in.
Due to the walk-in nature of appointments, urgent care clinics typically do not have a pre-registration process. However, when a patient requests an appointment, the front desk employee or receptionist must collect some basic data for billing purposes.
Important details include:
- Name, address, birth date, and basic demographic data, such as the purpose of the visit.
- Name, address, and policy number of the insurance provider.
In theory, data collected during registration will make it easier to create an electronic health record (EHR). Within the EHR, providers and support workers will collaborate to create patient notes, record medical histories, recommend treatments, and more. A current patient record with in-depth notes greatly streamlines the billing procedure. It’s crucial to record any patient demographic or insurance information at each visit if a patient is a frequent flier.
Make sure you have the funds
A walk-in clinic often lacks the time to call insurance providers and get pre-authorization for services. Patients should be aware of the details of their insurance plan and the charges they can anticipate from a walk-in clinic. Each patient must sign an affidavit of financial responsibility before obtaining medical care in order to prevent any potential billing disputes.
Follow-Up After Visit
All procedures and pertinent data should be entered into the EHR as soon as a patient receives services from a doctor or another provider. This aids in the preparation of an accurate bill to make the claim creation and patient balance collection easier.
Submission of the Claim
After each medical operation has been accurately coded. Reviewed for regulatory compliance, the billing process is complete when it is sent to the payer. The insurance company’s bill contains all the pertinent details on the diagnosis, procedures, and associated costs. An correct bill ensures a quick reimbursement procedure, which makes it more likely that you, the healthcare provider, will be paid promptly.
The majority of medical practices submit claims electronically since it is the most precise and quick way to get paid. In general, medical software facilitates the logging of patient data and the production of claims for payment.
Medicare billing for urgent care
Since after-hours treatment is more expensive, urgent centers can typically charge more for their services using S codes. However, CMS might be less likely to pay for urgent care services, and billing mistakes simply serve to slow down the payment process. Medicare treats urgent care facilities as primary care offices even though it uses a unique facility code (POS-20) for them (i.e., using codes POS-10 or POS-11). Medicare will pay urgent care providers for the services they provide, but it’s crucial to remember that they could not be reimbursed for the facilities’ additional costs associated with offering walk-in care. As a result, medical professionals who want to boost their earnings should maximize the number of patients who are privately insured.
The Price of Billing for Urgent Care
When it comes to handling your urgent care billing, you have two major choices: hiring internal coders and billers or contracting out the work to a specialist. Software licensing and other costs are necessary for both. Having in-house billers and coders is usually more expensive, even if some people prefer having complete control over the billing process. In-house staff will require payment of salaries and benefits. An absence or an unexpected termination of employment might have a negative impact on your operation.
Why Would You Outsource Billing?
In your practice’s revenue cycle, appropriate, economical practices are essential. Resource efficiency and revenue growth are two benefits of outsourcing:
- You can get year-round billing assistance from an outsourced billing business without having to budget for unforeseen employee absences. Additionally, this gives your personnel more time to devote to patient care activities.
- In general, billing companies perform delinquency collections better than internal workers.
- Spend less on workplace gear and software expenses.
- One of the primary motives for urgent care centers choosing to outsource is convenience. A billing service provider conducts all data entry, corrects denied claims, and charges patients. An EHR interoperability solution makes data transfer seamless.
- Allow your team to concentrate on patient-care duties, such as providing kind, research-based care that attracts more patients to your doors.
- The danger of billing and coding errors will be decreased through outsourcing. Which has two benefits: first, it streamlines the billing process and increases collections. Second, it assists with maintaining compliance with regulatory bodies like the Office of the Inspector General. The Centers for Medicare and Medicaid Services so that your practice is safe (CMS). Even unintentional noncompliance has expenses that can affect your revenue cycle management healthcare.
Guidelines for billing urgent care
Many of the same diseases that primary care offices analyze and treat are also treated by urgent care facilities. Therefore, the billing procedure is fairly comparable. There are, however, a few primary care codes that start with a “S” that are exclusive to urgent care.
Originally assigned by BCBS, S Numbers are Healthcare Common Procedure Coding System (HCPCS) codes that are now widely accepted by various payers. Only urgent cares use them, and some payers demand that they pay facilities back for the services they provided.
When it comes to coding and paying for services delivered, urgent centers primarily have two choices:
S9088, also known as “services given in an urgent care center (list in addition to code for service)”. Permits urgent cares to bill for the diagnosis and treatment of medical issues while acknowledging that the cost of services in an urgent care facility is fundamentally greater. The S9088 code must be billed along with the proper evaluation and management (E/M) code; it cannot be used on its own. The S9088 code enables urgent cares to get paid for at least some of the higher costs associated with giving quick care.
S9083 – Allows urgent care to charge a flat rate regardless of the patient’s course of treatment. In certain circumstances, a managed care organization (MCO) will demand a facility bill using the S9083 code. In fact, urgent centers are required to bill all services under S9083 by MCOs in some jurisdictions, including Florida and Arizona.
Generally speaking, if at all feasible, try to stay away from the S9083 code.
The explanation is straightforward: under a global fee-for-service system. Your urgent care facility will be compensated equally for treating a nosebleed and a heart attack.
These two codes—S9083 by itself and S9088 with the proper add-on CPT E/M codes—account for the majority of urgent care visits. Nearly all encounters, with the exception of Medicare, can fall under these two categories. While there are a few more S codes that may be suitable for urgent care practices. Medicare has distinct codes, and the amount that is reimbursed is determined, among other things, by location and a finding of established medical necessity.
Before being sent to a patient or payer, a bill must adhere to a number of legal criteria, such as HIPAA and the Office of the Inspector General compliance. A biller must also make sure that each charge is legitimately allowable under the terms of the payer. Denied claims can prolong the billing process, use up resources and labor, and be time-consuming.