Urgent Care Billing – Complexities and Solutions 

Urgent Care Billing – Complexities and Solutions 

Urgent care billing is unique and often complicated. Your needs are specific and so is the billing cycle of your center. An urgent care center must provide unparalleled patient experience in order to sustain, which is why billing should be left to those with necessary knowledge, tools, and manpower. There is a lot that you cannot outsource, fortunately, billing isn’t one of them.  

Many urgent care owners insist upon keeping their billing functions in-house as a means to retain more control. However, this is precisely what makes you lose out on revenue. See what happens – 

  • Rare expertise – It is no easy feat to find a biller who is adept in all areas of billing. With its numerous urgent care billing complexities, it is certainly not a one-person job and is better off being delegated to a partner with through knowledge of urgent care billing guidelines and the ability to scale.  
  • Coding – Many centers lose out on revenue, either because they are not aware of the critical importance of coding, occurrence of coding errors or because they are unable to keep up with the constant changes. A trusted partner, however, brings with it an army of qualified coders who know exactly what they are doing.  
  • Compliance – An urgent care center has a lot going on, even without bringing compliance guidelines into the mix. With ever-changing laws and complex urgent care CPT codes it is not practical for you to be able to stay on top of every minor change. However, such minor changes can cost you in the form of coding audits and even penalties. This is why the healthcare industry is joining hands with partners who can ensure that they stay complaint.  
  • Hiring costs – For starters, where are you going to find an expert in urgent care billing. It is a rare expertise. And even after you have crossed that hurdle there is always the risk of losing an employee to illness, injury, termination, or resignation. This can lead to you falling behind in collections and translate into significant losses.   
  • Claim formatting – Claims must be done precisely, and if there is so much as a code or digit not in order, there is the risk of denial. An in-house coder cannot be expected to maintain that level of efficiency, especially at a busy center. 
  • Credentialing – Sometimes you encounter situations in which a payor requires individual credentialing. This process can take up to 6 months and even the tiniest mistake can set you back months. Lack of domain knowledge can cost your practice significantly. 
  • Negotiating bad contracts – A contract with a payer creates a legal agreement that the payer will market your urgent care center as in-network in the payer’s network directory and reimburse your center per the contracted fee schedule. Your staff may not be able to negotiate an acceptable reimbursement rate on behalf of you, and this will have a marked impact on your bottom line.   

How do you find the right partner for urgent care billing solutions? 

It’s important to find one who understands the complexity of urgent care centers. Here are a few things to look for in entering a partnership: 

  • Credentials – Outsourcing partners must have a benchmark of quality service. They should also support your business, mission, and values. We encourage you to ask for KPIs and quality assurance measures to assess whether your requirements are being adequately met.  
  • Accuracy – Most challenges and oversights begin at the front desk. Data entry errors made at this point can have a domino effect on claims. It’s important to find a partner that prioritizes and understands the importance of accuracy.  
  • Availability – Look for a partner that provides all year availability and no employee down time. An urgent care must be available for the most unexpected of your needs.  
  • Specialists – Billing requires specialty knowledge, make sure your potential partner possesses the knowledge and expertise to manage the intricacies of billing and is staffed with certified coders. 
  • References – Look for a partner that comes highly recommended. Reading testimonials from other clients is one of the best ways to learn about performance and track-record. Do your homework.  

Learn more about urgent care billing solutions specifically designed to meet your needs here 

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