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Urgent care billing mistakes

Possible Urgent Care Billing Mistakes and How to Fix Them

Healthcare landscapes are ever-changing, resulting in the rapid growth of urgent care centers. Many urgent care centers have wait times of 30 minutes, and visits are no longer than an hour. Errors in urgent care billing will cost your center more than a few cents per dollar. They can be costly – sometimes even at the cost of your center’s success.

These are the most common urgent care billing errors that you probably aren’t aware of:

Failure to Fix Poor Front Desk Processes

When a new patient arrives to register, it is a complex process that frequently results in errors. If a patient’s data is incorrectly entered, the claim will be delayed and most likely have to be resubmitted. One of the most common errors in urgent care billing is the lack of dependable processes that start at the front desk. Co-pays should be accumulated at the beginning of a patient’s visit rather than at the end. There is an increase in bad debt and lost revenue if urgent care billing procedures are not followed correctly.

How to fix it 

The first step toward resolving this issue is to create financial processes that begin at the front desk and train your front-desk employees. Schedule retraining meetings regularly to ensure your staff is constantly updated on your operations.

Negotiate Bad Contracts or Have No Contracts at all

Contracting with payers established a legal agreement. The payer will market your urgent care center as in-network in the payer’s network catalog and reimburse your facility according to the contracted fee schedule. You cannot accept insurance if you have not established contracts with payers in your region when your urgent care center opens. One urgent care billing mistake makes it nearly impossible to generate the patient volume required to break even.

Negotiating low reimbursement rates with payers isn’t preferable because you won’t be compensated much for your patients’ services. The contracted rates must be reasonable and indicate the scope of services offered by your urgent care center.

How to fix it 

Hire a contract professional to negotiate your payer agreements on your behalf. A contracting expert will be familiar with the best reimbursement rates in your region and can help you prevent expensive mistakes and delays.

Not knowing or following the 2021 E/M criteria

Regarding E/M coding and regulatory revisions, 2020 and 2021 were years of significant change. During the pandemic, new CPT codes were developed to assist clinics in managing COVID-19 testing, telehealth visits, and vaccination delivery. E/M coding requirements were dramatically modified in January 2021 to help providers. If your workforce is not entirely up to date on how to code in light of developments, you may be losing money. Furthermore, your claims may be incorrect, necessitating revision and delaying reimbursement.

How to fix it 

Establish robust financial systems, beginning with your front desk, and ensure that all employees are taught about them. Retraining should be done regularly to guarantee that those practices are constantly followed.

Filling The Claim Incorrectly

Filling out a claim can be a confusing procedure, and missing relevant information and providing unnecessary details on a claim might result in a claim being denied. Some payors, for example, demand the National Drug Code (NDC) to be documented in a particular format on the health record. On the other hand, others do not require the NDC but will refuse the claim if it is presented in a format other than the payer’s preferred format. 

How to fix it

An experienced urgent care billing firm understands how to handle the complexities of claim submission to avoid denials.

Failure To Adhere To Credentialing Guidelines

Many individuals confuse contracting and credentialing, although the two are entirely separate processes. Credentialing is how a payer evaluates a provider’s experience, knowledge, and qualifications to assure patient safety. Each payer has its credentialing standards, so don’t make the same mistake of assuming that no credentialing is required just because one payer didn’t need any. Having payer agreements isn’t enough unless you have facility agreements. You must ensure that your providers are linked to your practice’s payers so that claims may be processed accurately.

How to fix it

Hire a credentialing professional to assist you in overcoming payor credentialing standards.

Inadequate Documentation or Under-Coding Chart

Even if you have unique electronic medical records systems, your EMR will only be as good as the doctors. Failure to place documentation in the proper locations may result in unintended under-coding, resulting in less income for the facility. Providers must also verify that all history, examinations, and MDMs are correctly documented in the EMR system so that the office visit codes accurately represent what occurred during the visit.

How to fix it

Ensuring providers are fully informed about using the EMR system is essential to proper urgent care facility billing. Training sessions are necessary to remind you how to use the EMR system from time to time.

Work with Billing and Coding Professionals

Fixing these urgent care billing errors might result in significant revenue improvements for your clinic. If your center is experiencing these mistakes and you need help fixing them, consult with a professional urgent care billing company specializing in urgent care revenue cycle management.

We provide provider credentialing along with assisting you in avoiding costly errors. We can collaborate with your urgent care center to prevent denials and ensure you’re receiving as much money as possible from payers to maintain your revenue cycle strong. Contact us to learn more about how our medical billing services can provide you with the necessary resources to tackle difficulties practically.

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