Urgent Care Billing

/Urgent Care Billing

Top 5 Urgent Care Billing Tips

Because of the number of steps involved in the claims creation process, it’s very common for there to be some mishaps in urgent care billing. For that reason, it becomes very easy for clinics and health facilities to be underpaid for urgent care services. To avoid this possibility, consider the five most important urgent care billing tips identified below.

Establish your contracts

If your clinic does not have its contracts properly established with the local payers for medical services, you have little hope of being paid on time or in the proper amounts. You should have all these contracts in place before you even open your clinic ideally, so that you’re not negotiating while waiting to be paid for claims. If you are obliged to negotiate contracts, you won’t be able to accept patients’ insurance coverage, and that means you’ll only be able to operate on a cash-only basis – which means you’ll have very few patients.

Use good front-desk practices

Front-desk personnel should be trained to check the current insurance for every patient, rather than asking if anything has changed since their last visit. This can help eliminate some improperly filed claims, for instance those with inaccurate demographics, addresses, or insurance numbers. When anything is submitted to a payer which is not accurate, it can result in having to re-submit, or having the claim denied altogether because it was sent to the wrong payer. It’s also a good idea to have your front-desk personnel audit denied claims periodically, to see if there are any trends associated with those denials.

Don’t overlook valuable charges

In the day-to-day hectic pace of a medical facility, it can be very easy to overlook some valuable charges, and therefore miss out on an entitled payment. Some of the most common oversights are injections, X-rays, blood draws, lab work, and reading of results. The volume of drugs dispensed is another area of fairly common oversight, and thus underpayment. Make sure your staff has been trained to identify and include these frequently missed charges, so you don’t end up providing free services.

Make sure to use the right billing codes

Choosing a lower-level 2 or 3 code might seem to be just right when billing charges are being coded, but higher-level codes are often justified and should be used in those cases. Your medical practice could be losing a significant amount of money daily by underestimating the code levels on charges. In addition, the American Medical Association regularly updates codes, and there have recently been thousands of new codes added to the compendium of charges. Make sure your office personnel are aware of these new codes, and that the correct ones are used during billing.

Use the correct code modifiers

Code modifiers help to identify the service which was delivered to a patient, and they provide additional information beyond the base code on any given charge. Although code modifiers are often essential for identifying just what kind of service was administered, these modifiers are often overlooked entirely or misused, thereby conveying an inaccurate picture of the service which was delivered. Make sure your staff are well-versed in using these code modifiers, and that they have a good understanding of which code modifiers are accepted by all payers.

Top 5 Urgent Care Billing Tips2019-01-02T17:52:43+00:00

Four Tips to Enhance the Collection of Copayments in Your Urgent Care Center

As many as 100 new urgent care clinics open their doors annually, according to the American Academy of Urgent Care Medicine. In an article published by the Healthcare Financial Management Association (HFMA), author Karin Kaplin writes that urgent care is projected to grow nearly 40%, to $18 billion, by 2017. And with each new clinic comes coding and billing challenges related to high-deductible health plans. Does the patient actually have active insurance coverage? If so, what is his or her specific copayment or deductible for urgent care services? This information is not always printed on the insurance card itself. Most importantly, how can front-end staff members educate patients about the ‘ins and outs’ of these requirements?

Collecting copayments is particularly challenging for urgent care centers that must meet Emergency Medical Treatment and Labor Act (EMTALA) requirements. EMTALA prohibits these centers from delaying screening or stabilization services to inquire about an individual’s payment method or insurance status.

According to CMS, provider-based urgent care centers may be required to meet EMTALA requirements if they are defined as ‘dedicated emergency departments.’ CMS defines these departments as those “held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment.”

Without a clear plan in place to collect copayments up front, urgent care centers subject to EMTALA may find themselves chasing after payments retrospectively. This creates an unhealthy accounts receivable from which it becomes difficult to rebound.


Consider these tips to keep cash flowing

Following are four tips that urgent care centers can use to enhance the up-front collections process:

  1. Provide staff education. Urgent care staff members can’t educate patients unless they, themselves, understand the nuances of various health plans. Can they clearly articulate the differences between a coinsurance, copayment, and deductible? Can they explain to patients why an urgent care copayment is usually higher than that of a physician office visit but lower than that of a ED visit? Create cheat sheets to address general or common questions, and keep insurance phone numbers handy when more specific questions arise. It also helps to get to know your provider relations representatives at each insurance company.
  1. Automate the eligibility process. Do staff members have online access to an eligibility clearinghouse or real-time eligibility tool? Some solutions use a provider’s internal data to estimate the cost of services that will be rendered. This empowers front-end staff to engage with patients about what they will owe and why. These solutions can also predict other details such as the deductible owed, copayment by service level, and lifetime wavers for particular services.

Note that your outsource coding and billing vendor may be able to provide low-cost or no-cost access to these types of tools and serve as a resource for billing questions.

  1. Communicate clearly with patients. This includes re-designing the center’s medical bill so that it clearly states the balance due using an itemized list of services and costs.
  1. Provide payment options. Make it as easy as possible for patients to pay for their urgent care services by accepting credit and debit cards as well as cash.

To learn more about compliant urgent care coding and billing, contact Nancy Dolgin at NEMB at 508-297-2068 x232.


About NEMB

New England Medical Billing is a fully HIPAA compliant Medical Billing Management and Administrative Service Firm. Our expertise is in program and system design as well as effective implementation and administration. Our multi-disciplinary approach and attention to detail consistently yields the maximum allowable returns on every client project.

Since 1993 NEMB has been built carefully, approaching each new engagement using proven management methods. Our superior, time-tested approach is applied to each and every engagement. We “zero-base” every new proposal to build a process that fulfills the unique requirements and goals of each project.

NEMB specialists, each of whom has been credentialed by the American Academy of Professional Coders (AAPC), have mastered the coding and billing guidelines pertaining to freestanding urgent care centers. We know what and how to bill services according to payer-specific physician contracts and can help our clients maximize appropriate reimbursement.

Four Tips to Enhance the Collection of Copayments in Your Urgent Care Center2019-01-02T20:40:13+00:00