urgent care billing

Urgent Care Billing Challenges: You Must Need to Know

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the relevant procedures, and provide staff training and retraining workshops to ensure that your practices are never out of date.

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.

Inadequate Coding and 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.

Top Urgent Care Center Billing Errors and Solutions

Healthcare environments are constantly changing. As a result, the number of urgent care centers continues to grow rapidly. Their ability to provide health care services quickly, efficiently, and affordably has made them extremely popular. Many urgent care facilities have wait times of no more than 30 minutes, and visits are no longer than an hour.

However, even if the urgent care market is doing well, billing and coding errors could cost urgent care centers a lot of money. Any mistake could determine whether or not a center is successful. Take a look at these urgent care billing mistakes and how to avoid them.

Failure to Improve Front Desk Procedures

The revenue cycle for urgent care center billing begins at your front desk. One of the most common mistakes in urgent care billing is the lack of dependable processes that begin at the front desk. Co-pays should be collected at the beginning of a patient’s visit rather than at the end. Prior balances must be collected before new services can be provided to patients. If urgent care billing procedures are not followed correctly, there may be lost revenue, an increase in bad debt, and an increase in patient accounts that go into collections.

The first step toward resolving this issue is to establish financial processes that begin at the front desk. Train your front-desk employees on all of the necessary procedures. Regular retraining sessions should be scheduled to ensure that your staff is always up to date on your procedures.

Having Unfavorable Contacts

When establishing contracts with payers, you must enter into a legal agreement with the payer. The payer reimburses your facility according to your contracted fee schedule and then markets your facility as an in-network center within their network directory under this agreement. You can’t accept insurance if you don’t have contracts with your payers, so increasing patient volume becomes much more difficult.

When you negotiate bad contracts, urgent care center billing is almost as bad. If your contract has a low reimbursement rate, you’re barely making a living for the services you provide to patients. You must have fair reimbursement rates in place, ones that reflect the full range of services you provide from your urgent care center.

Higher reimbursement rates can be difficult to negotiate. However, you may be able to negotiate higher pay rates with payers. You might consider hiring a contracting expert to handle your negotiations and ensure you get the best reimbursement rates possible.

Inadequate documentation or chart under-coding

Even if you have excellent electronic medical records systems in place, your EMR will only be as good as the providers who use it. Failure to document items in the proper locations may result in unintentional under-coding, resulting in less revenue for the facility. Providers must also ensure that all history, exams, and MDMs are correctly documented in the EMR system so that the office visit codes accurately reflect what occurred during the visit.

Making sure providers are well educated on how to use the EMR system is an important part of proper urgent care center billing. Refresher courses are useful from time to time to remind you how to use the EMR system.

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