In the US, urgent care centers continue to expand. Patients who require immediate attention but do not require emergency room care can use the services of urgent care facilities. These can be acute illnesses or injuries that require immediate attention.
Urgent Care centers have become an essential function within the healthcare system. It provides faster, more accessible and affordable care to patients for non-life-threatening conditions and diseases.
What is Urgent Care Billing?
Urgent care billing is the process of submitting claims for healthcare services provided at urgent care centers. It ensures that reimbursements are received on time with the use of accurate coding, verifying insurance, and managing claims.
Timely billing in an automotive framework is an essential function that involves complete and accurate paperwork submission for the processing of insurance claims for services rendered. This includes manual review of necessary documentation for completeness and accuracy for services covered under the policy. This is not simply a paperwork submission; tracking the status of submissions throughout the claims process is involved.
Steps involved in Urgent Care Billing Services
1. Patient Registration & Insurance Verification
The first step in the medical billing process is accurate patient registration. It is vital to collect patient's name, address, date of birth and contact information. Information related to insurance including policy numbers and payer information is important. Insurance verification identifies any co-pays and deductibles and allows the patient's coverage to be deemed acceptable. Careful attention to insurance verification prevents errors in billing.
2. Documentation of Services
Each healthcare provider documents every service provided to patients. Proper documentation ensures the medical coders and billers have comprehensive and correct information for the level of service provided. Sufficient documentation also helps with compliance with payer requirements and laws.
3. Medical Coding
Certified coders take the documentation from the care provider and apply standardized medical codes. Diagnosis codes like ICD-10 codes are provided to inform why the service was provided. Codes for procedures provided and modifiers convey exactly what occurred with the patient. Coding is essential because it will impact reimbursement and compliance. Errors in coding can result in claim denials, payment delays, and trigger an audit from payers.
4. Creation and Submission of Claims
When coding has been finalized, claims are produced through medical billing software which organizes all patient, provider, and service information in the appropriate format. Claims are then sent electronically or by mail to insurance payers for processing. Uninterrupted cash flow is only possible through prompt and accurate claims submission.
5. Claims Adjudication
After the claims are submitted, insurance companies will review the claims. The payer assesses the claims to verify correctness, eligibility, benefits, and consistency with payer policies. These will be accepted, denied, or returned requesting additional information. The results of the claims, once adjudicated, will be sent to the provider via an Explanation of Benefits (EOB), or Electronic Remittance Advice (ERA).
6. Payment Posting
Payment posting includes entering payments received from respective insurers and patients into the variable billing system. Payment posting provides visibility into which claims have been paid, partially paid, or denied. Accurate posting allows the billing team to settle the accounts, as well as determine if there is a discrepancy in payment, and to continue follow-up if necessary.
7. Patient Billing & Collections
Once the insurance payments have been posted, the remaining patient responsibility will then be billed to the patient. Statements will be sent to the patient along with payment options. Clear communication and clear statements can reduce confusion and ensure that the billing process is understood, leading to improved collections.
8. Denial Management & Follow-Up
The denial is reviewed to see the reason, which may be a coding issue, not enough or incorrect information an eligibility issue. The billing group must address the denial and correct and resubmit the claim. The provider will get maximum reimbursement if continuous follow-up with the insurance company is maintained.
Reporting & Regulatory Compliance
Regular reporting provides crucial data that is useful for measuring a company's financial and operational performance. The reports generally focus on claim submission acceptance rates, days in account receivable (A/R), and the percentage of collections. Managing these metrics provides the company's billing process the ability to find inefficiencies, measure progress, and ensure that payment is complete and accurate.
Compliance focuses on ensuring a company is following federal and state regulations like HIPAA, as well as compliance initiatives established by the individual payers. Regular monitoring allows consistency and accuracy, transparency, and compliance in the rev cycle.
Challenges of Urgent Care Solutions
- Eliminating Coding Errors
An increase in patient walk-ins can lead to coding errors. Using the wrong CPT code or mismatched modifiers can cause revenue loss. These errors often happen due to outdated codebooks or failure to track payer updates.
- Missed Diagnosis Codes & Denials
Denied claims waste time, money, and focus. Missing diagnosis codes or unclear medical necessity slow revenue. Many urgent care centers fall behind on appeals because of overburdened staff.
- Urgent Care & Immediate Payment
Urgent care demands prompt payment, but many centers still use outdated systems. Patients often forget or delay payment, making collections difficult and slow.
- Keeping Up with Regulations
Urgent care billing is under constant scrutiny as new CMS rules, payer policies, and laws like the No Surprises Act require compliance. Audits can take place, or there can be a delay in payments, even if there are small errors.
- Accurate Patient Demographics
Typos or missing information can cause claim rejections. Fast intake often leads to wrong insurance IDs, misspelled names, or incomplete forms. This delays claims and forces billing teams with an additional burden.
- Timely Insurance Verification
Treating patients without verifying insurance leads to denials. Many centers check eligibility late or after hours, increasing the risk of rejected claims.
Why Outsource Urgent Care Billing Services?
By outsourcing urgent care billing, the potential for errors and claim denials is reduced. The staff will remain up-to-date on CPT codes and modifiers and payer regulations. Claims will be submitted, followed up, and collected promptly with an outsourced patient accounting department, which will speed up the revenue cycle. With high patient volume, the staff will not be overwhelmed because the outsourced billing department will consistently keep up with billing and collections. The outsourced company and their staff will ensure compliance with CMS rules, waiver policies, and federal laws removing the potential for an audit.
The chance for claim rejections is lower because insurance and patient information are captured more accurately, and outsourcing tends to be less expensive than maintaining a complete in-house team to perform billing.
Urgent care billing outsourcing allows providers to reduce costs by 80% with rates starting as low as $7 per hour. Vendors provide billing services as well as full end-to-end revenue cycle management, allowing focus on patient care.
