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How to Avoid 5 of the Most Common Urgent Care Billing Mistakes

How to Avoid 5 of the Most Common Urgent Care Billing Mistakes

Urgent  care clinics are becoming more and more popular with many different populations, including families, millennials and seniors, making use of their services.

Whether the is a standalone practice or part of a larger medical organization, it will have to deal with all the same medical billing regulations and rules as any other medical provider, plus some conditions that apply specifically to urgent care clinics.

Medical billing for urgent care includes a set of codes for each type of diagnosis and treatment given as well as rules specific to the facility type.

Coding and billing is made even more complex when additional specialized services are offered, which can require additional skills for radiology and laboratory billing services.

Get Medical Billing Right from the Beginning

Starting a new urgent care facility is expensive, and it takes time to build up a regular patient base, so it is imperative that urgent care offices have efficient medical billing from the start. Avoiding these common mistakes will help keep an urgent care center from losing money due to avoidable errors.

  • Not starting the billing process when the patient contacts the facility. When a patient calls for an appointment or approaches the desk as a walk-in, a system should be in place to verify their insurance information, determine what will be covered, and collect payment of any co-pay, coinsurance, or any other amount the patient will clearly be responsible for.
  • Lack of clarity on pass-through billing. It’s important to stay clear on when laboratory billing services will be taken care of by a lab for work that is sent out and when they allow pass-through billing and the urgent care should handle the claim. Failure to have a clear procedure can result in lab services not being billed or being billed by both places, which is duplication and can result in charges of fraud.
  • Missing payer credentialing and contracts. If the urgent care doesn’t have a contract in place with each insurer and payer, they won’t be paid. It is important to find out who the common local insurers are and get them to approve the urgent care in their system. You’ll also need to negotiate reimbursement rates with them.
  • Not being approved for imaging and laboratory billing. If the urgent care provides lab services like x-rays or blood, urine and flu tests, it is important to ensure that credentialing is in place so payers recognize the facility as being qualified to do the lab testing so the bill will be paid.
  • Inexperienced medical billers and coders. Medical billing is complicated under the best circumstances. There are thousands of codes and modifiers that must be used absolutely correctly or claims will be denied. There is no give and take with payers; they don’t try to make corrections, they just reject the claim if there is any missing or incorrectly formatted information. The urgent care’s billers will be responsible for figuring out what the problem is.

Outsourcing to professional medical and laboratory billing services is the most effective way to handle urgent care revenue cycle management. An established company like Medcare MSO will have experienced billers who understand the intricacies of billing for urgent care. They can ensure that common but avoidable errors such as misspelled names and missing dates don’t occur so there are fewer claims rejected. When a claim is denied, they will be able to swiftly determine what the problem is and get it corrected and appeal the claim so that the urgent care gets paid.

As urgent care facilities continue to expand their services, the number of advanced billing and coding points the billers have to be familiar with will continue to increase, making it ever more efficient to delegate the billing to a professional organization that specializes in medical and laboratory billing services.

In addition to billing and coding, Medcare MSO provides full medical revenue cycle management (RCM), from payer credentialing to handling old AR and compliance reviews. Having a professional billing company handling your coding and billing can make running an urgent care center much more efficient and rewarding.