Major Challenges in Urgent Care Billing and Coding – NEO MD

The best strategy to eliminate urgent care billing errors is to outsource your practice's billing to a reputable medical billing company with qualified staff.


Urgent Care Billing
Urgent Care Billing
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The number of Urgent Care facilities is growing quickly as the healthcare sector develops. Their ability to provide quick, low-cost, and efficient medical care makes them popular. The fast-paced setting and unpredictable variations in patient flow make Urgent Care Billing more complex than other medical billing scenarios.

Here are some common challenges to remember. For instance, you may have to bill twice for the same medical service due to an error by a coder. This problem is even more likely if more than one person inputs billing information. To avoid double billing, you should double-check patient billing information and prevent multiple coders from entering billing details.

What is Urgent Care Billing?

It encompasses the complete claims-filing process, including ensuring that all supporting data is in order and that medical necessity is present. Urgent Care Billing is a complicated process. While it follows similar procedures to primary care billing, the coding and billing processes are not identical. Any hiccups in the process can negatively impact your revenue cycle management. Outsourcing your Urgent Care Billing can help streamline the process, eliminate redundancies, and improve collections, giving you more time to focus on patient care.

A typical billing method for Urgent Care services is using a code called S9088. This code enables Urgent Care to bill for their evaluation and treatment services. While these services are often more expensive than non-Urgent Care, this code can help Urgent Care get reimbursed for those higher costs. For instance, Urgent Care can bill for a medical evacuation if an emergency isn’t life-threatening.

Current Challenges in Urgent Care Billing

Urgent Care Billing and coding services can help you make the most of your revenue while minimizing risks. Regardless of the type of Urgent Care business you own, outsourcing can help you simplify your workflows and reduce costs. Using a professional Medical Billing service is also a great way to ensure that you comply with regulatory requirements. Non-compliance with government regulations can impact revenue cycle management. Urgent Care Billing and coding services evaluate the same conditions as primary care providers, and the billing process is similar. However, there are some important differences between Urgent Care and primary care billing. Urgent Care Medical Billing services use specialized codes that start with “S.”

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It is necessary to follow the urgent care billing and coding rules. For example, if an Urgent Care provider fails to pre-authorize the patient’s insurance, the claim is more likely to be rejected. In addition, Urgent Care practices do not have enough time to ensure that their patients’ insurance fully covers them. It is costly if errors occur during the payment process.

Urgent care billing
Urgent care billing
  • Urgent Care Coding Regulations

If you run an Urgent Care business, you have likely already seen the new code set released by the American Medical Association. This is the first significant overhaul in twenty-five years and primarily focuses on outpatient evaluation and management services, which are the main business drivers at Urgent Care facilities. For example, it eliminated the history and physical exam code. It allowed providers to select based on the time the patient was seen, making it easier for billing offices to charge higher rates.

The billing process for Urgent Care services is similar to the one used by primary care practices, except for the code for Urgent Care. Both the billing and coding process must be accurate and compliant to avoid hiccups in revenue cycle management. If you’re unsure where to begin, here are some helpful hints.

The Urgent Care Coding Regulations are a complicated set of rules, and many Urgent Care facilities did not have the time to adjust their systems to accommodate the changes. One of the essential aspects of Urgent Care Billing is using Category 1 CPT codes. These codes are used in most Urgent Care Medical Billing services. In general, the most common category is 99214, which is more complicated and reimburses more. Another category is 99204, the most frequently used code for new patients. This code requires a thorough history and exam and moderate medical decision-making. This code has a high reimbursement rate and a low risk of noncompliance.

  • Limited Time to Confirm Insurance

When choosing an Urgent Care center, it’s essential to understand that many will accept your insurance. This way, you can minimize your out-of-pocket costs. However, if you don’t have insurance, you can still use a tool like Solv to find prices and book an appointment that will be hassle-free. 

  • Urgent Care Billing Prior Authorization

One of the biggest challenges of Urgent Care Billing and prior authorization is the ability to bill more than a primary care office. Urgent Care may use higher S codes to bill for services and recognize the higher treatment costs after hours. However, CMS may not pay Urgent Care for these services, so billing and prior authorization mistakes can delay reimbursement. Urgent Care should know the proper billing and coding procedures to avoid misunderstandings.

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While coding guidelines for Urgent Care are similar to those for primary care, they are often different. An Urgent Care coder must determine what codes are appropriate for different medical services and comply with insurance provider rules. The claim will likely be denied if an Urgent Care provider doesn’t pre-authorize a patient’s insurance before billing for services. Moreover, most Urgent Care providers don’t have the time to call insurance companies for coverage confirmations. Without pre-authorization, a denial can significantly affect a clinic’s revenue.

In general, Urgent Cares bills are under Category 1 CPT codes. The S9083 code, which represents the evaluation and treatment of an acute medical condition, is the most commonly used. However, it isn’t as complex as the 99214 codes, which are used for services like emergency room visits. While both codes require a comprehensive examination and history, 99204 is the most common code for new patients. It requires a moderate amount of medical decision-making.

  • Centers for Medicare and Medicaid Rules

If you are looking to file a bill for a patient who was seen at an Urgent Care center, you will need to know the Centers for Medicare and Medicaid Rules for the Billing and Coding of Urgent Care Services. These rules govern how a doctor must bill for services covered under Medicare. The doctor should apply a code for such ailment if the patient has not previously received professional care within three years. It is necessary to properly document these codes and submit them as medical records.

Although the billing and coding for an Urgent Care service are similar to that of a primary care office, the CMS rules for Urgent Care are different. While Medicare does not recognize Urgent Care as a separate entity from outpatient physician offices, the procedures performed at Urgent Care centers are often coded using the E/M codes from the CPT manual. Urgent Care centers rarely use S codes, reserved for non-urgent medical services.

  • Medicare Limitations

The primary reason to outsource your billing for Urgent Care is to decrease the risk of error. Outsourcing your Urgent Care Billing and coding process to a third-party provider will streamline the billing process and ensure compliance with regulatory agencies. 

For instance, you cannot bill for an opioid antagonist with an opioid overdose. In addition, you cannot bill for this service on its own. CMS will not reimburse you for this if you bill the patient for a combined procedure with more than one ordering practitioner. This is because Medicare considers the combined procedure a single service, resulting in payment for one service over another. However, if you are a part of an extensive network, you may be subject to additional rules and restrictions related to using codes for Urgent Care.

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How can NEO MD handle Urgent Care Billing?

Our committed team of medical coders and billers can help you grow your practice. Our staff complies with all Medicare Urgent Care Billing and Coding rules to ensure maximum reimbursement. Real-time, precise, quick, error-free coding of each claim and an early assessment to ensure claim eligibility reduces the risk of claim denial and refusal.  Leading US revenue cycle management companies are in charge of many newly – built healthcare facilities. Most healthcare organizations probably accept the services of just a few medical billing companies.

NEO MD Medical Billing has been working with different Urgent Care centers across the US. With more than 15 years of expertise in billing for emergency rooms and outpatient clinics, we have created innovative solutions that have transformed the revenue cycle management industry.

NEO MD also provides medical billing services for small, medium-sized, and large practices. Additionally, we offer customized billing services to practitioners throughout all US states. So, for acquiring services, the healthcare facilities find us the best Medical Billing company near me.

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

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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