- June 27, 2024
- Posted by: Josh Knoll
- Category: Urgent Care Billing
Your Urgent Care practice is thriving – you have a good patient volume; you have positive reviews online and have hired providers dedicated to providing evidence-based, compassionate care – but your profit margins are still not what you expected. The truth is, taking good care of your patients and managing the financial stability of your practice do not require the same expertise. You also need a dedicated staff which can take care of your Urgent Care billing and coding processes. Only an efficient billing staff can steer clear of billing challenges and pave the path for smooth, uninterrupted collections.
Learn more about the fundamentals of Urgent Care billing and coding and how you can boost your revenue with just a few tweaks. Let’s get started.
How does Urgent Care Billing Work?
Urgent Care facilities work as a gap between the primary care provider and the emergency room. That is a major reason for their increasing popularity among patients of all kinds. In fact, the expected market growth of Urgent Care is $ 36,280 million by 2030, witnessing a CAGR of 4.9% during the forecast period 2024-2030. To command your fair share in the market you must understand the basics of Urgent Care billing and coding.
Starting at the Front Desk: Urgent Care billing is a cycle that starts at the front door. You must ensure the correct information is collected at the front desk, right from the patient’s demographic information to their medical history, and everything in between. Any error within this information will affect your revenue generation.
Financial responsibilities: As Urgent Care services do not require prior authorization you must ensure the patients understand their financial responsibilities within the process. Furthermore, your staff should collect the co-pays and deductibles upfront to ensure a smooth transition of the billing process.
Claim transmission: After each medical service is coded and checked for regulatory compliance, it is sent out to the payer. The bill the insurance company receives includes essential information about diagnosis, procedures performed, and associated charges. An accurate bill ensures streamlined and smooth operation and reimbursements.
Coding Guidelines for Urgent Care Billing
Once a patient encounter is complete, the medical coder typically translates all the diagnoses and procedures into medical codes based on the recorded documentation. CPT codes are used with ICD-10 codes for accurate billing. CPT codes usually come under 3 categories:
Category I CPT codes have descriptors that correspond to a procedure or service. Codes range from 00100–99499 and are generally ordered into sub-categories based on the procedure performed or service rendered.
Category II CPT codes are alphanumeric and are supplemental codes for measuring performance. Using them is optional.
Category III codes are temporary alphanumeric codes and are used for developing technology, procedures, and services.
Urgent Care providers often perform services or procedures that are similar to primary care. However, there are ‘S’ codes that make the Urgent Care billing and coding a more intricate process.
S0988 or “services provided in Urgent Care facilities” allows your facility to bill for evaluation and treatment of medical conditions. This code does not stand alone – it must be used with appropriate evaluation and management code.
Another code S0983- allows your facilities to charge a global fee for services, regardless of the type of treatments patients receive. In some cases, managed care organizations (MCO) require a facility to bill under S0983. For instance, the states of Florida and Arizona- require that urgent care bill all services under the code S0983.
The Cost of Urgent Care Billing
When it comes to handling your Urgent Care facility’s medical coding and billing, you have two main options – hiring in-house coders or hiring outsourced staff.
While you think having an in-house billing and coding staff will help you control your revenue, the overhead costs for providing physical space, technology, and wages can create a burden on your facility. Furthermore, you have to invest a humongous amount of time and effort to train, educate, and retain those employees.
Considering this notion, most of the providers across the country are focusing on hiring an outsourced team. A team of expert medical billers and coders can handle your administrative tasks and enhance your revenue management at a fraction of the usual cost and minus all the associated hassles.
Sunknowledge – Your Trusted Partner for Efficient Urgent Care Billing
We at Sunknowledge Services Inc. have been providing solutions to both payers and providers for more than a decade. With great references and versatility, we can provide you with an end-to-end revenue cycle management solution.
Only with us, you can experience:
- 99.9% accuracy
- Reduction of overhead costs by up to 80%
- 100% HIPAA compliance
- Constant monitoring of claim submissions
- Consistent communication with the stakeholders
- AR follow-ups and defined denial management
You can have all this support at just $7 per hour. Along with that, you will have the benefit of industry-comprehensive best practices and technology within your billing and coding practices. With consistent reporting, our revenue cycle management experts help you gain control over your revenue cycle. If you are looking for a reliable partner who can drive your Urgent Care’s ROI in a positive direction, connect with our experts today!