Urgent care is growing in scope and the types of services offered, especially in some areas where it is increasingly used by certain populations as a substitute for primary care (PC) either due to lack of PC physician availability or medical insurance coverage.
For those centers that provide PC-related care as well as emergency, there is sometimes a question of whether to bill as primary care or as urgent care.
In filling gaps between primary care and emergency room care, urgent care facilities provide an increasingly critical service within the healthcare system. As a result of the growth in the industry, urgent care clinics are expected to have a worth of over $26 billion by 2023.
To capture your share, you need to ensure that your billing and revenue cycles are at peak performance.
Medical Billing Begins at Patient Arrival
For walk-in cases, a center’s front desk should collect insurance billing information as well as the primary care provider, if applicable.
While pre-registration isn’t normally encountered, getting information up front can reduce billing errors and delays or denials later. Verification at the time of service is often not possible, so the more information that can be obtained, the likelier the claim will be paid.
Most (over 81%) urgent care facilities contract with and bill payers as urgent care rather than as a primary care provider. Given that reimbursement rates are higher for urgent care, as well as offering other benefits, it makes sense for most urgent care centers to bill as POS-20 (urgent care) rather than POA-11 (primary care).
These S-codes are part of the Healthcare Common Procedure Coding System (HCPCS) and were originally created by BCBS but are now utilized by many other insurers. S-codes are only used by urgent care centers, with many payers requiring them for reimbursement.
Contracts can vary and sometimes services can overlap, creating confusion whether to bill as primary or urgent care. Since urgent care centers generally provide services for true emergencies, the patient may either be unable to provide insurance information or there’s no time for any pre-authorization before performing a procedure.
Other factors that can complicate billing are the types of services offered for non-emergency cases. For many people, urgent care or emergency rooms have replaced care from a family physician, either due to lack of available practitioners or lack of adequate health insurance coverage.
Differentiating Codes for Urgent Care from Primary Care Is Important
Reimbursements for services billed as urgent care POS-20 tend to be paid 30% higher than if billed as POS-11 and are often paid faster, as there are fewer mistakes holding up claims. It’s therefore to a center’s advantage to keep non-urgent cases to a minimum whenever possible. It is also critical that front desk personnel collect as much information as they can up front, such as insurance verification, to minimize delayed or denied reimbursement.
Another benefit of urgent care billing using POS-20 is establishing a more consistent record of providing urgent care in those markets, which justifies higher reimbursement for surrounding centers. Additionally, recognition as an urgent care facility offers more justification for higher rates when negotiating contracts.
This is where working with dedicated urgent care medical billing services can pay for itself many times over, thanks to accurate coding and billing according to the terms of each contract.
Outsourcing Urgent Care Billing Increases Revenue
Outsourcing billing services can help your urgent care center cope with year-round billing, which is especially useful when your own staff may be experiencing downtime during holidays, illness or time off. Centers can avoid delays in processing and reimbursement that can result from key billing personnel being unavailable.
Billing companies are generally better at handling delinquent accounts, which regular in-house staff may be reluctant or unable to handle.
An outside billing service also increases revenue by reducing coding and other billing mistakes, ensuring a more efficient billing process, and seeing that the practice is compliant with agencies including the Centers for Medicare and Medicaid Services (CMS) and the Office of the Inspector General (OIG). Incurring noncompliance penalties, even if the violation was unintentional, can deeply cut into your revenues.
Finally, using an outside billing agency is simply more convenient: they ensure data entries are accurate and applicable to the charges billed, fix delayed or rejected claims, and invoice patients. Your regular staff members are freed up from billing tasks to focus on providing what they do best: provide quality patient care.
Urgent Care Reimbursement for Facilities
The amount of time it takes to receive reimbursement for services depends on the type of charges incurred, the contract terms, insurance and other coverage verification issues which may be overlooked or unavailable and the efficiency of the billing service used. Overall, as long as the patient’s chart shows no coding, diagnosis or treatment errors or raises other questions when sent to the billing service, when a claim is billed “clean,” reimbursement should be forthcoming in a timely manner.
Normally, urgent care billings can be expected to be paid anywhere between 2- 6 weeks, with the patient billed anywhere from a month to as long as 15 months (or more) after the date of service. That said, if a bill goes through auto-adjudication, processing can take place within 24 hours.
However, if it needs to go into pending review, the insurance company may take several weeks to process, paying the doctor and healthcare facility separately. There is no standard time frame, as some offices may send out an estimate (but not an actual bill) of anticipated reimbursement and subsequent money owed by the patient.
Patient Payments for Urgent Care
One of the most common questions patients ask Google regarding medical billing for urgent care is,
“Does urgent care bill you later?
Before coming into an urgent care facility, they need to know what to expect. In most situations, an explanation of benefits (EOB) will be sent by the insurer to the patient showing what was billed, any amounts to be written off by the provider, what was paid by insurance and any amounts applied to a patient’s copay and deductible.
The efficiency and accuracy of the urgent care facility’s billing and coding departments play a large role in billing and reimbursement timeframes, which makes choosing an experienced and highly-rated billing service one of the top financial decisions for an urgent care center’s management.
Consider Urgent Care Medical Billing Services to Streamline the Billing Cycle
It is important to remember that while urgent care billing is often complicated, it follows similar procedures to those used by primary care providers, including coding and other billing guidelines and compliance with regulatory standards.
Any interruptions in the billing process, such as billing or insurance verification errors can disrupt the revenue cycle and have a negative impact on the center’s bottom line.
Working closely with a qualified, experienced medical billing service familiar with the urgent care industry can effectively streamline billing operations for urgent care and walk-in centers while improving revenue collection through more accurate, complete claims submission.
Medcare MSO has a team of experienced urgent care medical billers on staff so we can confidently offer our guarantee of increased revenue if you decide to turn over your urgent care billing to us.
We offer all aspects of revenue cycle management and have developed a system that allows us to step in and take on your billing without disrupting business or your cash flow. Give us a call today at 800-640-6409 to learn more or talk to a representative if you have any questions.