Urgent Care Billing Challenges: How-to Overcome them?

Many factors influence the urgent care billing industry. There are numerous variables that can complicate urgent care billing, including changes in patient behavior, trends in patient payments, and the current global pandemic. Urgent care billing is constantly evolving, and we’d like to take a moment to discuss some of the challenges the industry is facing.

Front-of-House Processes That Are Inefficient

All processes in urgent care billing facilities begin at the front desk. Many facilities struggle because there are no dependable systems available. Instead of collecting co-pays at the end of a patient’s stay, it should be done at the start.

It is strongly advised that previous balances be collected before providers provide any additional services to their patients. Failure to follow these procedures may result in revenue loss and bad debt.

To address these issues, having financial systems available at the front desk is a good place to start. Ensure that the front desk staff is familiar with the relevant procedures, and provide staff training and retraining workshops to ensure that your practices are never compromised.

Contract Flaws

You require precise reimbursement rates that represent all of the services provided by your facility. Many doctors sign payer contracts without bargaining. To resolve this issue, try negotiating a reimbursement rate increase with your payers. When discussing these issues, having a medical billing company assist you can help you get the best reimbursement rate for you.

Under-Coding and Improper Documentation

Even if you have a fantastic EMR or electronic medical system, you still need your providers to use it correctly. If providers do not properly document, you may accidentally under-code or over-code. This can result in revenue loss for your practice.

Check that your providers understand how to use your EMR system and that the notes are accurate. Consider doing refresher courses with your staff on a regular basis so that they are always aware of the proper way to use your facility’s EMR system.

Mistakes That Can Occur During Urgent Care Billing + How to Avoid Them

The healthcare industry is constantly changing, and urgent care is one of the areas that is expanding rapidly. This growth is due to a variety of factors, including how efficiently and affordably health care services can be provided. Many urgent care facilities have people waiting, no more than half an hour for services, and visits rarely last more than an hour. Despite this efficiency, urgent care centers could lose a lot of money if coding and billing errors occur. Here are some of the mistakes that can occur during urgent care billing and how to avoid them.

Suboptimal Front Desk Procedures

The front desk is where the entire revenue cycle begins, and poor financial processes that begin here can frequently lead to revenue loss. Co-payments should be collected whenever a patient arrives for a visit rather than waiting until the visit is finished, and any prior balances a patient has should be collected before any additional services are offered to them. When there are no good processes in place at the front desk, practices can lose revenue, resulting in significant debt.

As a result, you must implement better financial processes. Train your front-desk staff on all new processes you implement, and make sure they are retrained on a regular basis.

Contract Flaws

A legal agreement is formed when contracts are established with payers. This agreement calls for the payer to reimburse your facility based on the fee schedule you established. Your facility is also listed as an in-network center in their network directory. If you do not have contracts with any payers, you will be unable to accept insurance, making it much more difficult for your facility to bring in patients.

It is almost as bad to negotiate bad contracts as it is to have no contracts. This is because your facility will not be adequately reimbursed for any services you provide to patients. Your contract’s reimbursement rates should be reasonable and cover all of the services provided by your urgent care center.

Insurance companies will always be adamant about reducing their expenses, so raising reimbursement rates is difficult, but negotiating higher compensation from payers is an option. Using the services of an experienced contractor can often be an effective way to handle these negotiations.

More Errors in Urgent Care Billing

Insurance billing is a critical component of your Urgent Care medical practice, and errors in this area will cost your practice a lot of money and jeopardize its success. While we have previously discussed mistakes in urgent care billing, there are still some to avoid, and we want to go over them with you. Here are some more urgent care billing mistakes to be aware of.

Failure to Follow Appropriate Credentialing Guidelines

Some people believe that credentialing and contracting are the same thing. However, this is not the case because they follow different processes.

Credentialing is a process in which payers verify providers’ qualifications and expertise in order to keep patients safe. Different payers have different credentialing requirements, and even if a payer did not require any kind of credentialing, it would be a mistake to assume that you don’t need any credentialing at all.

Unless you already have facility contracts, payer contracts will not suffice. Keeping payers and providers connected is essential for the proper claim processing. This is why you should enlist the assistance of a professional credentialing company to assist you with the requirements of payer credentialing.

Accidentally committing “Locum Fraud”

When outside providers do temporary work at clinics, questions about proper billing procedures frequently arise. Even if mid-level nurse practitioners and providers are from locum agencies, you may not be able to bill them under locum regulations.

To clarify, locum tenens physicians cover for other doctors. Because the pay for mid-level providers may be lower than that of physicians in some cases, you cannot bill these providers as if they were physicians.

If you make this mistake, you may be reimbursed for a larger amount than you are entitled to, and you will be committing fraud. To avoid making this mistake, physicians should only be billed as locum tenens. 

Incorrectly Filling Out Claims

It can be difficult to file claims correctly, and you might include too much or not enough information. Leaving out critical information or including unnecessary information can both result in claims being denied.

It is in your best interest to choose urgent care billing services to avoid this type of problem. They will know exactly what information is required when filing claims, preventing your practice from receiving denials and losing revenue.

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