Compared to primary care medical billing and coding, urgent care billing and coding is more difficult. The complexity of urgent care billing is exacerbated by different payer reimbursement policies, frequent coding updates, and high deductible health plans. Up to 100 new urgent care facilities open each year, according to the American Academy of Urgent Care Medicine, but the majority of them struggle to generate a healthy amount of revenue because of urgent care billing issues. Prior to the COVID-19 Pandemic, urgent care billing was fraught with difficulties, and things only got trickier during the pandemic. PPE shortages and sharp swings in the number of inpatient visits were problems that urgent care had to deal with. Like most medical specialties, urgent care made an effort to adapt to new billing regulations in order to survive. The following problems affected urgent care clinics the most out of all those they encountered over the past 1.5 years.
Challenges for Urgent Care Billing
Introduction of Telemedicine
Urgent care providers were compelled to use telemedicine services during the COVID-19 pandemic in order to lower risk by remotely managing patient testing. While urgent care facilities managed this altered patient care successfully, they lacked the necessary time to plan for the new billing regulations. It led to incorrect claims being submitted, a higher percentage of claims being denied, and rework on denied claims. It became increasingly difficult to find time to work on training and improving the current billing process as visit volumes rose.
Not adhering to updated E/M guidelines
For COVID-19 testing, vaccination administration, and telehealth visits, new CPT codes have been added. To aid healthcare providers during this pandemic, the majority of E/M guidelines were revised. You might have lost a lot of money if your team wasn’t informed about these E/M revisions. The majority of urgent care providers submitted billing without a proper understanding of the updated E/M guidelines, which led to claim denials and a delay in reimbursement.
Uninsured Patient Program Portal
The COVID-19 Uninsured Patient Program Portal was launched by the Health Resources & Services Administration. This programme was made available to providers as a way of paying claims reimbursements, typically at Medicare rates, for diagnosing, treating, and immunizing COVID-19 patients who lack insurance. Reimbursement for claims submitted through the portal presented numerous challenges for urgent care providers. Although clinics were paid at Medicare rates, they frequently spent more money seeing patients than was covered by that rate. Clinics were unable to submit claims for additional fees related to an existing claim because claims could only be submitted once. Undocumented patients had difficulty obtaining accurate identification and information, and it was challenging to correct rejected or returned claims for these patients because there was no appeals process for amended claims.
All throughout the pandemic, urgent care centers were impacted by patient confusion. The exposure to viruses, telehealth options, testing locations, test eligibility, and COVID-19 service coverage all caused patients to feel anxious and uncertain at the same time. Clinic employees had to respond to more inquiries than ever as patients sought clarification and assurance from their nearby healthcare professionals in addition to meeting the high demand of patients who needed tests. Patients expected the COVID-19 testing and care at urgent care centers to be free, but some were given bills based on their insurance coverage, which led to annoyance and billing errors.
Confusing COVID-19 Coverage
Not patient care, but rather the business of providing healthcare, particularly with regard to medical billing and coding, is one of the biggest challenges facing doctors today. This also applies to billing for urgent care services. You might be able to free up time to concentrate on patient care by outsourcing your billing and coding for urgent care.
Top Urgent Care Center Billing Mistakes, And Their Solutions
Landscapes in the healthcare industry are ever-changing. Because of this, urgent care facilities continue to grow significantly. They are extremely well-liked because of their capacity to deliver health care services in such a quick, effective, and cost-effective manner. There are often no waits longer than 30 minutes at urgent care facilities, and visits rarely last longer than an hour.
While the market for urgent care services is experiencing good business, billing and coding errors could cause urgent care centers to lose a lot of money. Whether a center is successful or not could depend on any error. See how these urgent care center billing errors can be corrected.
Failure to improve poor front desk procedures
The healthcare revenue cycle solutions for an urgent care center begins at your front desk. Lack of dependable front-desk processes is one of the most frequent billing errors in urgent care facilities. Instead of at the end of a patient visit, co-pays must be taken up front. Before introducing new services to patients, previous balances must be collected. Improper billing practices at an urgent care facility can result in lost sales, an increase in bad debt, and an increase in patient accounts that are sent to collections.
Establishing financial procedures that begin at your front desk is the first step in solving this issue. Your front desk staff should receive thorough training in all procedures. To make sure that your staff is always up to date on your procedures, schedule regular retraining sessions.
Having Bad Contacts in Place
You must enter into a legal contract with the payer when setting up contracts with payers. The payer will pay your facility in accordance with the fee schedule you agreed to, and they will then promote your facility as an in-network center in their network directory. Building a patient volume will be much more challenging if you don’t establish contracts with your payers because you can’t accept insurance without them.
When you negotiate bad contracts, urgent care billing is essentially no better than it is now. You are hardly getting paid for the patient services you provide if your contract has low reimbursement rates. In order to accurately reflect the full range of services you provide, including your urgent care, you must have fair reimbursement rates in place.
It can be challenging to bargain for higher reimbursement rates. However, you might be able to persuade payers to offer you higher compensation rates. It might be a good idea to work with a contracting specialist who can handle the negotiations and ensure that you receive the best reimbursement rates possible.
Incorrect Documentation or Under-Coding Charts
EMRs are only ever going to be as good as the providers using them, even if you have excellent electronic medical records systems in place. The facility could lose money if items are accidentally undercoded as a result of incorrect documentation of items in the proper locations. In order for the office visit codes to accurately reflect what happened during the visit, providers must also make sure that all history, exams, and MDM corrections are documented in the EMR system.
Educating the providers on how to use the EMR system correctly is a necessary component of proper urgent care Centre billing. To serve as a reminder of how to use the material, refresher courses are helpful from time to time.