Turn your Claim Denials into Approvals with an expert Urgent Care Billing Company

Urgent care centers operate around three main components that include speed, access, and patient satisfaction. The clinical workflows in such a quick care facility have adapted to the patient’s urgent requirement for treatment. In doing so, the claim denial rates in the reimbursement process have also increased significantly. The denial patterns are closely linked to patient volume, office-visit workflows, and incorrect documentation. A professional urgent care billing company helps to reduce these claim denials and improve the reimbursement rates for acute care services.

Why do claims get denied in urgent care facilities?

Denied claims create delayed payments, further leading to reduced reimbursement rates and increased administrative burden. The reasons behind payment denials include:

1.    Duplicate claims – Patients may visit the urgent care centers on the same day for additional assistance. This creates confusion among the in-house billing staff and leads to duplicate submissions for the same patient. These overlapped claims in urgent care are often flagged by CO-18 denial codes. The major reasons behind repeated claim submissions are clerical errors, accidental resubmissions, and missing modifiers. Sometimes, technical issues in the outdated billing software also create the submission of identical claims more than once.

2.    Inaccurate coding techniques – The application of outdated, incorrect, or mismatched codes in urgent care billing may result in claim denials, reduced payment rates, or audits. The focus lies on CPT codes that are majorly used in urgent care services like lacerations, rapid diagnostic testing, or infusion administration.

Using the following incorrect Evaluation and Management level codes can result in denials if documentation supports a higher level of care:

•    99213
•    99214

Medical coders might not be updated with the latest coding guidelines published by the American Medical Association. Insurance companies deny claims that are not submitted with updated codes and modifiers.

3.    Outstanding unpaid claims – Urgent care centers operate with a high patient volume and limited billing resources. The in-house billing team members are involved with patient treatment, leaving them with no time to follow up on the denied claims. In the absence of timely insurance claim tracking, denials arising from lack of medical necessity, inaccurate coding, or missing modifiers may translate into permanent revenue loss.

4.    Claims with shorter turnaround times – Urgent care centers handle a high volume of patients. Most of them have waiting time of less than 20 minutes for treatment. This creates an urgent need for rapid, high-volume claim turnaround time, to maintain a healthy cash flow. There are more claims to process but with less time available, ensuring that claims are accurate. Errors are evident that, leading to denied claims and delayed reimbursement. This happens mostly due to the fast-moving nature of urgent care services, creating the need for faster but flawed documentation methods.

The importance of S codes in urgent care denials

Besides the use of CPT codes and modifiers, urgent care billing also involves the application of S codes. However, many insurance companies deny S-code claims. The major reasons behind this denial include:

•    Missing payer contract authorization – Claims are denied when the insurance contracts do not specifically authorize the use of S codes for urgent care visits. These codes are usually created and managed by commercial insurance companies. Therefore, billing them without a confirmed contractual approval leads to claim rejections or delay in reimbursement.
•    Incorrect application of billing models – Denials are common when the billing structure does not match the payer’s reimbursement model. The insurance claim might not align with the payer's processing logic if a global urgent code is submitted in place of evaluation and management codes.
•    Lack of clinical documentation – It is important to note that S codes may represent bundled urgent care services. However, insurance companies still require detailed clinical documentation of urgent care treatment. When documentation does not clearly capture the patient’s history, exam findings, or medical decision-making, payers may determine that the billed S code is not adequately supported.

Overcoming the billing challenges and working on eliminating claim denials is quite a challenging task for an urgent care provider. These healthcare specialists are always running against time to ensure that patients receive timely and improved treatments. The implementation of best practices to ensure accuracy in the billing process consumes both time and effort, along with impacting the quality of patient care. In situations like these, an outsourced urgent care billing company is your one-stop solution for minimizing errors and maximizing profits.

The outsourcing advantage in urgent care billing

An urgent care facility operates to provide timely treatments to patients. The medical service is required on an immediate basis to cure the patient suffering from injury or other medical conditions. The process of providing urgent care requires a highly detailed billing system, with accurate documentation and coding. Urgent care providers often find it overwhelming to focus on the reimbursement besides providing medical care. For this reason, providers hire an outsourced urgent care billing company to ensure accuracy and efficiency in their reimbursement methods. These third-party companies offer benefits like 30 days’ free trial, no binding contracts, $7 an hour service charge, and dedicated account managers. Their team members are trained on the updated coding guidelines and industry regulations, which will reshape your entire urgent care billing system.

Their experienced and CPC-certified coders minimize errors and ensure clean paperwork for timely claim submissions. Their expertise in handling billing software like AdvancedMD, Tebra, and Experity ensures automation and reduces the chances for manual errors. They cover your end-to-end urgent care revenue cycle management. This consists of both pre-billing (documentations, eligibility verification, prior authorization) and post-billing (claim submission, denial management, AR follow-up) services. You can also benefit from their expertise in reducing the operational cost by 80%. If your urgent care clinic is constantly struggling with claim denials, it is time for you to outsource the task to an urgent care billing company. This will not only maximize revenue generation but also ensure that your patients receive an improved quality of urgent care service.