How to Reduce Denials in Urgent Care Billing

Managing the denial rate in Urgent Care billing

Some amount of denials is common in every form of medical billing, and Urgent Care billing is no exception. However, if they occur too often and in growing numbers, it’s a red flag situation for any Urgent Care business. Reducing the denial rate in Urgent Care billing is essential to ensure that claims are paid promptly and accurately. And therefore, it has a direct bearing on the final collections for a practice. Here are some steps that can be taken to reduce the denial rate:

Verify insurance eligibility: Before providing any services, it is important to verify the patient’s insurance coverage and eligibility. This will help to prevent claims from being denied due to issues such as expired coverage or incorrect policy information.

Accurate coding: Accurate coding is essential to ensure that claims are processed correctly. It is important to use the correct CPT codes, modifiers, and diagnosis codes, and to ensure that they are entered correctly in the billing system.

Document medical necessity: It is important to document the medical necessity of the services provided to support the claim. The documentation should clearly indicate why the services were necessary and how they benefited the patient.

Timely submission: Claims should be submitted promptly to ensure that they are processed in a timely manner. It is important to follow up on any claims that have not been processed within the expected timeframe.

Monitor denial trends: It is important to monitor denial trends and address any recurring issues. This can involve reviewing denied claims to identify common errors, implementing process improvements to address these issues, and providing training to staff to ensure that they are aware of billing requirements and best practices.

Utilize technology: Utilizing technology can help to streamline the billing process and reduce the risk of errors. This can include using electronic health records (EHRs), automated billing systems, and other tools to simplify the billing process and improve accuracy.

Going beyond the best practices

While it is easy to state that following these steps, urgent care centers can improve their billing processes and reduce the denial rate, putting them in practice can be a real challenge. The main impediment is a lack of adequately skilled and well-trained billing personnel that most Urgent Care facilities often find difficult to acquire.

In view of this, a growing trend can be seen in hiring external billers and coders who provide specialized assistance in all Urgent Care billing affairs. Such strategic outsourcing of billing operations results in better and easier adherence to the best practices already listed above, resulting in improved revenue cycle management and a better overall financial performance.