Health and Fitness

Urgent Care Billing: A Beginner’s Guide and Reasons to Outsource

Your urgent care business is prospering – you have a good patient volume, nice online ratings, and employees who are committed to providing evidence-based, compassionate treatment – but your profit margins aren’t where you’d like them to be. If your revenue isn’t up to par, it’s possible that your billing processes are to blame. Learn the fundamentals of urgent care billing and how to increase your practice’s revenue with a few simple changes.

How Does the Billing Process for Urgent Care Work?

Urgent care clinics bridge the gap between primary care and emergency rooms, which is critical in our healthcare system. That’s perhaps why they’re becoming more popular, with a market value of $26 billion predicted by 2023. To gain a fair portion of the market, you must first learn the fundamentals of billing and how to optimize your workflows for optimum profits.

Guidelines for Urgent Care Billing

Urgent care providers assess and treat many of the same issues as primary care physicians. As a result, the charging process is quite comparable. However, there are certain urgent care-specific codes – beginning with an “S” – that differ from primary care codes.

S codes are Healthcare Common Procedure Coding System (HCPCS) codes that were originally assigned by BCBS but are now accepted by many other payors. They are only used by urgent care centers, and some payors demand them to reimburse facilities for services provided.

Excellent Urgent Care Billing Procedures Begin at the Front Desk

Urgent Care billing is a cycle, and it starts at the front door. You may boost your revenues and spend less money on costly collection methods by establishing good financial practices that begin at check-in.

Due to the walk-in nature of appointments, most urgent care facilities do not have a pre-registration process. When a patient requests an appointment, the receptionist or front desk staff must collect basic billing information.

The following information is essential:

  • Name, address, birth date, and reason for visit are examples of basic demographic information.
  • The name of the insurance company, the name of the primary care physician, and the policy number are all required.

Ideally, information gathered during the registration process will aid in the development of an electronic health record (EHR). Providers and support personnel will collaborate within the EHR to create patient notes, record health history, and make treatment suggestions, among other things. An up-to-date patient record with detailed notes streamlines the billing process significantly. If a patient is a frequent visitor, make a note of any patient demographic or insurance information at each visit.

Confirm Financial Accountability

An urgent care clinic may not always have the time to contact insurance companies in order to secure pre-authorization for services. Patients should be aware with their insurance information and understand the charges they might expect to incur from a walk-in clinic. Prior to getting medical care, each patient must sign an affidavit of financial responsibility to avoid any billing disputes.

Following the Visit

When a patient receives services from a physician or other provider, all procedures and pertinent information should be recorded in the EHR. This aids in the preparation of an accurate bill, which aids in the formulation of the claim and the collection of the patient balance.

Submitting the Claim

After each medical operation has been properly coded and validated for regulatory compliance, the final step in the billing process is to deliver it to the payer. The bill sent by the insurance company contains critical information about the diagnosis, procedures, and associated expenditures.

The Cost of Urgent Care Billing

When it comes to urgent care billing, you have two options: hire in-house coders and billers or outsource the process to a professional. Both will necessitate the purchase of software licenses as well as other costs. While some prefer complete control over the billing process, having in-house billers and coders is more expensive. You will have to pay salary and benefits to in-house personnel, and an absence or unexpected termination of employment might have a significant impact on your process.

Why Should You Outsource Urgent care Billing?

Appropriate, cost-effective practices are critical in your practice’s revenue cycle. Outsourcing can assist in increasing revenue and optimizing resources:

  • Without having to account for unexpected staff downtime, an outsourced company can assist you with year-round billing demands.
  • When compared to in-house workers, billing services are often better at collecting delinquencies.
  • Reduce your office’s hardware and software costs.
  • One of the primary reasons that urgent care centers prefer to outsource is convenience.
  • A billing service provider conducts all data entry, corrects rejected claims, and distributes invoices to patients. With the assistance of an EHR interoperability solution, data transfer is seamless.

Urgent Care billing is complex, although it generally follows the same protocols as a primary care clinic. To remain in compliance with regulatory mandates, you must adhere to coding and billing guidelines. Billing errors can disrupt your revenue cycle management and have a negative impact on your practice’s bottom line. Outsourcing is a good way to streamline billing, eliminate redundancies, and improve collections while leaving your workers to focus on patient-centered care.

The Sunknowledge Advantage in Urgent Care Billing

There will be no backlog, and that is a promise! Partner with Sunknowledge to provide a thorough approach that will definitively upgrade your ROI. Over the previous decade, we have ensured that all urgent care clinics that partner with us have cut their operational costs by 80%.

We improve your collections with our effective front desk management and all the heavy lifting labor for just $7 per hour or 1.99% of all collections. Our crew is well-versed in all popular tools, such as DocuTap and others. Our client references are good, and we collaborate with the country’s major urgent care institutions, from which we have excellent testimonials. It gives us satisfaction to be able to drive reimbursements for the best without sacrificing quality or staffing requirements.

Even on weekends, when patient intake is high, we can work with you to resolve all of your operational issues once and for all. Hire us for consistency, productivity, and, most importantly, a specialized ability to serve as your perfect operational extension. We would be delighted to give you our experience over a no-obligation phone conversation.

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