How Accurate Coding Ensures the Success of Urgent Care Billing Services

Urgent care centers always play a vital role in the healthcare ecosystem as they ensure timely, accessible and dependable medical care for illnesses and injuries. The majority of urgent care practices often get overwhelmed when they need to handle the administrative side as well. You cannot take your revenue cycle management part lightly, as your financial side directly depends on it.

Healthcare practices in the U.S. spend almost $183 billion annually due to their inefficient RCM processes. Hence, proving the fact that clinical care is definitely crucial but that doesn’t mean you can afford to compromise on your financial side. Moreover, it is important to ensure perfect urgent care billing services, including both the pre-billing and post-billing steps, along with staying on top of all the payer guidelines. The good thing is that you can still ensure a robust RCM process by understanding what billing is and the frequently used codes in your urgent care services.

Understand the concept of urgent care billing services:

Urgent care billing is a systematic method of submitting claims and getting reimbursed for the services provided by you. You should not consider your billing job like a general billing method, as you primarily deal with walk-in patients. Most of your patients come without appointments and with various immediate medical needs ranging from minor injuries to serious conditions, making your billing process more cumbersome than regular practices. Each urgent care visit requires you to handle different codes, comprehensive documentation and different payer regulations. Many of your walk-in patients even come with multiple insurance plans or sometimes none at all, turning your billing process more complex and vulnerable to errors. You can ensure reduced errors, payment denials, and revenue loss by following an efficient billing process.

Unfortunately, most urgent care practices often face monetary loss because of billing errors, especially due to assigning the wrong codes. You can significantly improve your overall billing process by assigning accurate CPT codes and the following are the frequently used CPT codes-

Commonly used CPT codes in urgent care billing services:

The success of your billing process highly depends on how accurately you assign the right medical codes. You may also find some codes that are used in both primary care and urgent care. Here is an example- you need to assign CPT codes 99202-99205 for new patient visits, depending on the complexity and time spent. You need to use 99202 for a patient with a simple sore throat, while 99205 should be used for a patient needing a detailed exam for chest pain. Your administrative team needs to use the code range of 99212-99214 for established patients, but depending on the complexity and time. You need to assign 99212 for a patient who needs a follow-up for minor wound dressing and 99215 should be documented for a patient with complex asthma review. The urgent care coding team uses code range of 12001-13160 for documenting wound repair services like suturing deep cuts, treating skin lacerations. The other commonly used codes are-

• 36415: Assign such code for defining various blood collections
• 71045: It is a diagnostic test code for a chest X-ray, which helps record imaging performed to detect conditions such as pneumonia
• 93000: Assign this code for documenting ECG
• 87804: This code should be assigned for documenting influenza virus detection by immunoassay, a frequent test during flu season

You can actually enjoy fewer claim denials and timely reimbursements by assigning the correct CPT codes like above.

S codes are also commonly used in your billing practice but it primarily depends on the type of contract you have with the payer.

Know how S-codes matter in your urgent care billing services:

A special part of urgent care billing is the use of S codes. These are HCPCS Level II codes that help payers identify services provided in an urgent care setting. Let’s explore some S-codes examples here. You may need to assign S9083 for a global fee covering all services during a visit and use S9088 for documenting services performed in your urgent care setting.

It is really important to remember that S-codes are payer-specific, as some recognize it, while others do not, and that’s why you should carefully check each payer’s policy before submitting claims. Urgent care practices can ensure timely claims processing and prompt payments by assigning the right S-codes.

Your billing services travel beyond just assigning the correct codes, as you need to follow some critical coding guidelines as well. Here are the key guidelines that your administrative team should adhere to-

The key guidelines for using urgent care coding:

It is crucial to follow the right urgent care coding guidelines along with assigning the right codes. You should document the exact time that you have spent on face-to-face visits with patients for assigning the right time-based E/M codes. Your team should capture exactly how long you spent treating the patient for a prolonged visit. You must show the medical necessity by assigning every urgent care CPT code explaining why the treatment was required. You must assign the right point-of-service codes like POS 20 as it identifies the services that were performed in your urgent care center to avoid any potential conflict. You can differentiate the services done in a physician’s office or an emergency room by using the right POS code.

The truth is that many urgent care service providers still lack an efficient team to handle all the nuances of their billing, especially the coding part. You would be shocked to know that most practices lose at least $10,000 per year due to issue like undercoding alone. You certainly wouldn’t wish to forfeit the revenue rightfully owed to you—no one would. Now, the question arises here: what, then, is the most viable path forward? You can simply consider outsourcing urgent care billing services to a competent RCM service partner like SunKnowledge Inc.

SunKnowledge: Your ideal destination to get the urgent care billing sorted

Urgent care medical billing demands precision and a profound understanding of every detail and that’s where we come as your perfect guiding angel. Our decades of expertise in billing, coding, and end-to-end RCM services enable us to provide you with an unmatched experience. We have highly experienced billing experts who know how to streamline every step of your billing mechanism. We are the only RCM company that works for both payers and providers, helping you stay on top of your billing game. We know what it takes to maintain 99% billing accuracy with the whopping first-pass acceptance rate of 97% so that you can enjoy almost 80% savings on your existing operational costs. Our team works seamlessly across multiple time zones, providing unwavering support whenever needed at the most competitive rate of $7/hour!