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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

Urgent Care Billing: In House or Outsource?

One of the most important things that an urgent care center needs to consider is whether to outsource their billing or take care of it in-house. While in-house medical billing does give a practice more control over their billing practices, many urgent care clinics find that it’s more trouble than it’s worth.

As strange as it may sound, it’s in your best interest to outsource your urgent care clinic’s medical billing to a third party. Here are just a few reasons why.

Consistent Billing

Unpaid or denied claims are common for any medical practice. These can cause a major headache for obvious reasons, not the least of which is the time and effort it takes to address these claims. A medical billing company is contractually obligated to follow up on these claims, which takes most of the stress away from the urgent care clinic itself.

Having a third party handle all billing claims also means that all bills will be sent out on time and at a regular basis. Clinics that handle their billing claims in-house can easily fall behind on their bills and claims if they have a heavy workload. Medical billing companies focus exclusively on billing patients and sending claims to insurance companies, which means they don’t have to worry about treating patients or taking care of any other responsibilities that could cause them to fall behind on their work.


Medical billing companies also submit performance reports to a provider upon request. These reports provide transparency and allow a clinic to know exactly where it stands financially. This also allows an urgent care clinic to evaluate the services of the billing company itself.

Lower Costs

While it can be difficult for urgent care clinics to budget for medical billing companies, outsourcing medical billing can still lead to lower costs for clinics. An urgent care clinic that handles all of its billing in-house simply has a higher overhead. A billing department needs to be created, which means having to hire more employees and paying more in hourly wages and other benefits. There’s also the matter of creating a billing system, which can eat into the clinic’s budget even further. On the other hand, outsourcing work to a medical billing company allows an urgent care clinic to bypass all of this and simply focusing on other matters.


The experience provided by a medical billing company is unparalleled. Since medical billing is at the forefront of the business, medical billing companies have lots of experience in this field. In addition, they are well versed in all the rules and regulation of medical billing.  This minimizes room for mistakes and allows practices to feel confident in the ethics and experience of the medical billing company.

Better Service

Finally, outsourcing billing and claims to a third party allows an urgent care clinic to provide better service to its patients. Doctors and other medical professionals don’t have to worry about processing claims and sending out bills, so they can focus on providing high-quality treatment to those who need it. They may not have all of their billing information on hand at all times, but they can rest assured that it is in good hands while they focus on doing their jobs to the best of their ability.

Urgent Care Billing: In House or Outsource?2016-07-11T16:26:21+00:00

How We Help Credentialing for Your Urgent Care Center

An urgent care center is a good halfway point for those who need treatment for acute illnesses and non-life-threatening injuries yet don’t need to go to an emergency room. The wait time at urgent care centers is significantly shorter than what you would find in an emergency room, there’s always at least one licensed physician on staff, and it’s much less expensive. The only problem is that insurance companies can make it very difficult for urgent care centers to become credentialed.

What is Credentialing?

An urgent care center requires the proper licenses to operate in a particular jurisdiction, but it also needs to be affiliated with major insurance companies so it can accept third party reimbursement. This is known as credentialing, and it allows a center to receive steady payments and treat a greater number of patients. In other words, it is essential for the operation of any urgent care center.

Credentialing may seem like a simple matter, but it can be a major obstacle for an upstart urgent care clinic. First of all, the process can take as long as six months, so a center needs to get a head start on it if it is going to have a steady cash flow as soon as it opens. Second of all, the credentialing process varies from one payer to the next. The staff at New England Medical Billing stays up to date on the ever changing requirements for each payor.

How New England Medical Billing Can Help You

If you’re concerned that your urgent care center won’t be properly credentialed, you can always go to a medical billing service to assist in the process for you. That’s where New England Medical Billing can help you. We expedite every step of the credentialing process for urgent care centers. We can help you fill out all the proper paperwork, handle the communication between you and the insurance companies, make sure that all submitted claims are paid and generally ensure that you have a steady cash flow.

Running an urgent care center is a lot of work, and we want to help make things a little bit easier. Contact New England Medical Billing to find out how we can help you with all of your medical billing needs including credentialing.

How We Help Credentialing for Your Urgent Care Center2016-07-11T16:26:41+00:00