Today’s freestanding urgent care centers face ongoing operational and financial challenges. Patient volumes are on the rise as healthcare shifts toward outpatient care, making it difficult for front-end staff to incorporate the billing function into their daily routines. Freestanding centers must also adhere to coding and billing guidelines that include many nuances. Unlike ERs, these centers don’t have their own unique set of CPT codes. Instead, providers working in this setting must know what office visit E/M codes they can—and can’t—bill for the services they provide.
The confusion doesn’t end there. Provider enrollment and credentialing are also complex because each payer may have different contracting requirements. Payers also have specific requirements regarding patient referrals, deductibles, and copayments. As payers continue to diversify the products that they offer to consumers, these requirements will only become more complicated.
Staying abreast of ongoing regulatory and coding challenges is no easy task. Providers working in freestanding urgent care centers want and need the reassurance of knowing that they’re receiving all of the reimbursement to which they’re entitled. These days, every dollar counts, and providers must be able to predict future revenue so they can plan ahead. As the ICD-10 implementation date approaches, providers need to be as prepared as possible to mitigate denials, ensure documentation specificity, and keep the revenue streams flowing.
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.
Following is a list of the services we provide:
- Comprehensive coding and billing services. NEMB clients have the reassurance of knowing that credentialed specialists review each claim manually before submission. We catch errors and omissions before those claims are sent, saving clients significant resources and time spent chasing denials.
- Durable Medical Equipment (DME) billing. Not all payers allow providers to bill for DME and E/M services on the same claim. Many payers require separate claims for DME. NEMB takes the time to get to know each of your payer’s requirements. We ensure accurate reimbursement for DME and take the stress out of billing for DME items and supplies.
- Revenue projections. NEMB can predict with almost exact certainty the payment per case for any freestanding urgent care center. We use projected volume and projected payer mix to predict revenue as much as a year in advance. Freestanding urgent care centers use this information to plan their budgets and make strategic business decisions.
- Ongoing front-end staff education. NEMB specialists will train front-end staff members to become more efficient and effective at checking for referrals, checking eligibility, obtaining demographic information, obtaining proper copayments, and more.
- Provider credentialing and enrollment. NEMB specialists have experience in establishing freestanding urgent care centers from the ground up. This includes identifying service lines, setting up fee schedules, and enrolling/credentialing providers. As Medicare Administrative Contractors change, we go the extra mile to ensure that our provider clients are enrolled properly. We take the time to understand each MAC’s specific protocols. We provide ongoing support so that your center can open its doors with confidence and focus on providing top-notch clinical care to patients.
- Denial and appeal management. In this age of auditor scrutiny, denials are inevitable. However, NEMB works hard to mitigate denials and appeal them, when necessary. We don’t bill patients directly unless and until all efforts to work with the insurance company have been exhausted.
- Documentation audits. NEMB clients receive ongoing feedback regarding documentation insufficiency and areas for improvement. Our staff are PCA-certified physician chart auditors. We notify providers when documentation is lacking, and we strive to provide education and helpful tips.
- Detailed reports and analyses. NEMB clients have access to a whole host of reports on demand. These include monthly practice summary reports, physician productivity reports, E/M level distribution reports, procedure reports, average payment per case reports, and more. These reports can be customized to fit your center’s needs. NEMB has a robust database that specialists can use to extrapolate essentially any data that your center needs to assess or improve its business practices.
- Ongoing support and advice. NEMB clients regularly receive new information about ever-changing regulatory requirements. We encourage clients to contact us with questions about how these regulations may affect their businesses. Whether it’s ICD-10, Meaningful Use, Accountable Care Organizations, or other initiatives, we’ll work by your side to ensure that your freestanding urgent care is prepared.