Manage your High Patient Volume with an Expert Urgent Care Billing Company

A busy afternoon at any urgent care center shows how quickly billing demands can build with just few seconds. And it is not like the way in which a normal medical practice bills patients. The patients just walk in without any prior notification as at times many arrive without being scheduled in advance.

The waiting room becomes occupied from being totally vacant within twenty minutes, and the personnel work on cases ranging from a sprained ankle to streptococcus and much more.

Also, the American Academy of Urgent Care Medicine, report generally indicates that an urgent care center tends to attain around 60-80 patients per day. This indicates the kind of pressure a facility faces on a regular basis. Now imagine, every single encounter usually includes E/M services along with some additional procedures such as diagnostic tests, imaging, injections, or minor procedures. All of that speed puts real pressure on the revenue cycle, working quietly in the background.

A seasoned urgent care billing company makes sure the revenue cycle catches up with the pace of urgent care.

Why High Patient Footfall Creates Unique Billing Challenges

More patients through the door are usually good news, since more visits generally mean more revenue. But there is also something that nobody talks about enough. More volume indicates more opportunities for something to go wrong. It looks like this:

• Walking in with same-day patients that need immediate registration, usually without even knowing they would be coming that day
• Changing payer mix which keeps shifting from one payer to another during a day
• Evaluation and Management visits plenty of common coding level 99202-99215
• Point-of-care testing for strep, flu, and COVID-19, as well as lab tests that could either be done internally or sent out to a reference lab
• Plain film X-rays when a fracture is suspected, as well as vaccination, injections, and minor procedures such as laceration repair and splinting
• Occupational Medicine visits, including DOT physicals, drug screens, as well as school, sports, and employment physicals

Numbers must be taken into account while considering 150 patients’ processing within a single day; the problem is that 2% of any mistakes in their documentation or coding will inevitably cause substantial revenue loss. Thus, the key issue is not how fast such claims can be processed by the billing department, but whether it is possible to maintain such a pace consistently.

How an Expert Urgent Care Billing Company Supports High-Volume Patient Flow

Streamlining the Revenue Cycle From Registration to Payment

A revenue cycle that actually works starts well before anyone thinks about submitting a claim. It begins at check-in and runs through

• Eligibility,
• Charge capture,
• Documentation,
• Coding,
• Claim creation,
• Claim scrubbing,
• Claim submission,
• Payer adjudication,
• Payment posting,
• Denial management and AR follow-up,

Every step is reliant on the others. Suppose you get the patient’s demographic information wrong; the claim will be rejected no matter how flawless the coding is. Just like that, any discrepancy in the eligibility verification process may fail to uncover the lapsed status of a patient’s insurance plan, causing denials later. An expert urgent care billing company creates effective workflows that connect the front desk to the back office, to deal with such issues.

1) Real-Time Insurance Eligibility Verification

Most patients in urgent care facilities come unannounced, which makes prior eligibility verification impossible. A solid eligibility workflow usually checks:

• Eligibility, coverage status, and effective or termination dates
• Member ID along with copay and deductible amounts
• Whether primary and secondary insurance are in the correct order, along with payer-specific rules that could affect the claim
• Workers’ compensation details when they apply, and any authorization requirements that need to be sorted out up front

The point is simple: catch a coverage problem before or during the visit rather than after the claim has gone out. The first kind of problem that occurs is usually easy to fix, being merely a phone call or looking into the portal. The case that was denied because it was not eligible, however, is quite another thing, it requires more time and effort.

2) Coding Expertise That Protects Revenue Without Overcoding

A single urgent care visit mostly consists of several services. An E/M service often shows up alongside a care procedure. All these services need to be coded accurately using the right guidelines and complying with coding updates.

Also, at times, payers want to see codes like S0620 or S0621 for physical exams depending on whether they are a new patient or an established one. This is where the HCPCS S9083 global urgent care fee or S9088 to flag services rendered in a certified urgent care setting, which one really needs to be careful of. Not to forget even place of service matters too for its code 20 and getting that detail wrong is a common reason claims bounce back.

Any proficient urgent care billing company that knows this is not chasing the highest-paying code available. They make sure the level of service reported matches what the documentation supports, which protects against two problems. Undercode, and legitimate revenue gets left on the table and overcode without proper documentation; or else the practice will face more denials.

3) Charge Capture and Claim Scrubbing

One visit to an urgent care facility does not include just one service. One visit can consist of rapid testing, radiology services, nebulizer, injections, etc. The clinic gets slammed with patients, and therefore, the clinical team gets really busy providing services to them. However, it is quite understandable for them not to have enough time to make sure that all these services are recorded into the billing system properly.

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How an Urgent Care Billing Company Prevents Missed Revenue

That is exactly the point where charge leakage occurs. For instance, strep testing is captured in the medical record but is not billed on the claim. Splints are applied and recorded but do not get captured anywhere. The partnership with a professional urgent care billing company enables an establishment of a process through which the documentation is reviewed relative to orders, results, procedures, and finally the claims themselves in order to find any inconsistencies that could lead to a loss of income.

Additional review of the claims guarantees detection of all issues including demographic errors, bad diagnosis codes, modifier issues, duplicate lines, and improper coding due to National Correct Coding Initiative edits before the claim is submitted. When the claim is denied, it is certainly not an easy task.

4) Managing a Complex Payer Mix

The urgent care centers encounter a problem where the payer mix is heterogenous in nature and includes payers like Medicare, Medicaid, commercial insurance, employer insurance, and workers’ compensation, and so on. The amount to be paid for each type of payer varies along with deadlines and processes for appeals.

To put it simply, each payer follows their guidelines regarding urgent care reimbursements, and one may be more complicated than the other. The processing of the workers’ compensation claims is far more complicated and looks quite different from the commercial claim. An effective urgent care billing team has a thorough understanding of all these unique payer-specific criteria. They make sure not to apply the same rule for every claim they submit.

5) Reducing Administrative Bottlenecks

Patient volume can be a problem for the urgent care center’s ability to process billing if there is not proper coordination within the departments. Delays in documentation can lead to delays in coding, which will create delays in claims filing. Further, any delay in claim filing will result in unpaid claims leading to an increase in accounts receivable (A/R).

A good urgent care billing company will assist in managing this process in an effective manner through proper documentation review, charge capture, coding, claims, payments, and AR process management. By this, increased patient volume will not increase the administrative burden for urgent care facilities but will allow them to generate more revenues by fulfilling the patient requirements.

6) Denial Management and Accounts Receivable

Denials are not a matter of how busy an urgent care center is, but rather how many denials happened and why. The usual suspects tend to be:

• Eligibility problems and coding errors
• Missing documentation
• Modifier issues and duplicate claims
• Timely filing gaps, since many commercial payers only give a clinic 90 to 180 days to submit
• Authorization issues and coordination of benefits mix-ups
• Bundling or unbundling problems

An urgent care billing company worth working with does not treat every denial like an isolated fire. Denials get sorted by root cause. If a third traces back to eligibility, the fix is not throwing more people at fighting denials one by one. It is fixing the verification process and front desk workflow producing them in the first place.

Accounts receivable requires the same structured approach. There will be segmenting of the receivables based on the payer, aging, amount, and reason for denial. Then there will be follow-up based on the aging, from a less involved approach in the first 30 days to true escalation when the claim reaches the 90-day mark.

How to Choose the Right Urgent Care Billing Company

Not all medical billing companies are equipped for that kind of volume and complexity. Before you even begin considering using such a service, you may want to determine their capability to provide:

• Coding expertise in urgent care E/ M level coding, procedures, and documentation beyond general billing for primary care
• Ability to process a large volume of claims each day without compromising on accuracy and conducting true root cause analysis on denials instead of repeatedly submitting the claims
• Follow-through in the form of collection of unpaid or underpaid claims instead of leaving them untouched
• Transparency on your revenue cycle numbers instead of a fuzzy monthly summary
• Compliance with regulations at both the state and federal levels regarding billing
• Integration into existing EHR and practice management software with scalability in mind

Why Sunknowledge Is the Urgent Care Billing Partner Worth Choosing

High patient footfall is what makes an urgent care facility what it is, and honestly, it is also what makes the billing side so demanding. Every new patient is a revenue opportunity, sure, but it is also one more encounter that must be registered, verified, documented, coded, billed, and reconciled correctly.

This is exactly what SunKnowledge was built to ensure. We have earned our reputation as one of the most trusted names in urgent care billing by pairing urgent care specific coding expertise with industry specific requirements, backed by a denial management team that treats every clinic revenue cycle like it is their own.

Urgent care operators keep coming back to SunKnowledge because the numbers back it up:

• Clean Claim Rate always more than 99%
• First Pass Claim Acceptance Rate as high as 97%, keeping reworks to an absolute minimum
• Denial rates reduced using root cause analysis approach, as opposed to resubmissions
• Days in Accounts Receivable improved due to truly proactive Accounts Receivable follow-ups
• Charge Lag and Payment Lag kept low enough to ensure predictable cash flow
• Net Collection Rate and Reimbursement per Encounter measured and reported transparently

What make SunKnowledge special is not the dashboards or the technology, even though both stand out in this field. It is the people who drive them – certified coders, account managers and revenue cycle experts who really understand urgent care.

High patient volume should turn into high collected revenue, not more administrative headaches, and that is why so many urgent care centers now consider SunKnowledge the best urgent care billing company in the industry. Book an appointment with us today to learn how our services can help you.