Mastering Urgent Care Billing: Your Complete Guide & Benefits of Outsourcing

Your urgent care business is doing well – you have lots of patients, good online reviews, and caring staff. But you're not making as much money as you hoped. If your earnings aren't meeting expectations, it might be because of how you handle billing. Learn the basics of urgent care billing and how you can make simple changes to increase your profits. For those in the Sunshine State, understanding medical billing services in Florida can be a game-changer in maximizing your revenue.

How Does Urgent Care Billing Work?

Urgent care clinics are important in healthcare, fitting between regular doctor visits and emergency rooms. They're becoming more popular and could be worth $26 billion by 2024. To stay competitive, you need to know about billing and how to make it work better for you. If urgent care providers feel it is difficult to handle the billing side, they can choose to outsource the financial management to the urgent care billing services. In this way, healthcare providers can overcome financial issues and run their practice smoothly.

Billing Starts at the Front Desk

Billing at urgent care centers is a process that starts as soon as patients walk in. By having good financial rules from the start, you can earn more and spend less on collecting payments.

Most care places don't have patients sign up beforehand because people just walk in. But the person at the front desk still needs to get some basic info for billing:

• Name, address, birth date, and reason for visit.
• Insurance company name, primary doctor's name, and policy number.

It's best if this info helps create an electronic health record (EHR). Staff can use the EHR to write down patient notes, health history, and treatment plans. Having an updated record makes billing easier. If a patient comes back, make sure to update their info each time.

Making Sure You're Covered

When you go to a clinic, they might not call your insurance first. So, it's good to know what your insurance covers before you go. You need to sign a paper saying you'll pay for your medical care if your insurance doesn't cover it.

Keeping Track After You Visit

After you see a doctor, write down what they did for you in your electronic medical record (EHR). This helps make sure your bill is right and helps the clinic get paid.

Sending the Bill

Once everything is checked and coded correctly, the clinic sends your bill to your insurance. The bill tells your insurance what was wrong, what the doctor did, and how much it costs.

Why It Matters

Getting your bill right helps the clinic get paid faster. Most clinics send bills electronically because it's faster and more accurate. They use special software to do it.

When it comes to billing Medicare, urgent cares face some challenges. They can charge more for services after hours using special codes (S codes). But Medicare might not pay as easily for these services. Billing mistakes can slow down reimbursement.

Urgent Care Billing Medicare

Medicare labels urgent care centers with a special code (POS-20), but it treats claims like those from regular doctor's offices (POS-10 or POS-11). Medicare will pay for services at urgent cares, but it might not cover the extra costs of walk-in care.

To boost revenue, healthcare providers should focus on patients with private insurance.

The Cost of Urgent Care Billing

When dealing with billing, you've got two main choices: either hire people to do it in your office or hire professionals outside your practice. Both options come with costs like software licenses. But hiring in-house staff usually ends up being more expensive. You'll have to pay them salaries and benefits. Plus, if someone is absent or leaves unexpectedly, it can mess up your billing.

Why Outsource Your Billing?

It's important to manage your practice's revenue well. Outsourcing can help with this and has several benefits:

• Outsourcing means you have help with billing all year round, without worrying about staff being unavailable. This lets your team focus more on taking care of patients.
• Billing companies are usually better at collecting overdue payments than in-house staff.
• You save money on buying and maintaining software and hardware for billing in your office.
• It's convenient to outsource. The billing provider takes care of entering data, fixing rejected claims, and sending invoices to patients. They use a system that makes it easy to share information with your electronic health records.
• Outsourcing lets your staff concentrate on patient care, providing compassionate and evidence-based treatment to bring more patients.
• Outsourcing reduces the chance of billing mistakes, which helps your billing process run smoother and improves collections. It also helps keep your practice following the rules set by agencies like the Office of the Inspector General and the Centers for Medicare and Medicaid Services (CMS). Breaking these rules, even accidentally, can hurt your revenue management.

Coding Guidelines for Urgent Care Billing

Coding guidelines for urgent care are important. After a patient visit, a coder translates diagnoses and procedures into medical codes. These codes, like ICD-10 and CPT, are widely used in healthcare.

ICD-10 codes diagnose, while CPT codes show procedures done during care. They are used together to make patient bills.

CPT codes fall into three categories:

• Category 1 covers most areas like disease management, surgery, and radiology.
• Category 2 codes are optional for quality assurance.
• Category 3 is for new procedures and technology.

Conclusion

Urgent care billing can be complex. However, it generally follows similar steps as a regular doctor's office. To stay in line with rules, you need to follow coding and billing guidelines. Mistakes in billing can disrupt how you manage your money and impact your practice's earnings. Outsourcing can help make billing smoother. It cuts down on repetitive tasks and boosts how much you collect. Plus, it lets your staff concentrate on giving great care to patients.