Six Most Costly Urgent Care Billing Errors

Urgent Care Billing
Urgent Care Billing

If you work in medical billing and coding, you know that it’s often treated as a separate entity, but it’s inextricably linked to patient care. Every person who works in the medical billing department has a direct impact on revenue and the success of the practice, and urgent care billing and coding are no exception.

Billing errors will cost your urgent care center more than just a few cents. They can be very expensive – sometimes to the detriment of your center’s success. The following are the six most common urgent care billing errors you may not be aware of:

Negotiating or not having any contracts is a recipe for disaster

Contracting with payers establishes a legal agreement that the payer will market your urgent care center as in-network in the payer’s network directory and reimburse your center according to the fee schedule you agreed to.

 You won’t be able to accept any insurance if you don’t set up contracts with payers in your area by the time your urgent care center opens. That’s one urgent care billing blunder that makes building the patient volume, you need to break even, nearly impossible.

Failure to adhere to credentialing guidelines

Many people mistakenly believe that contracting and credentialing are the same thing, but they are not. The process by which a payer verifies a provider’s experience, expertise, and qualifications to make sure the safety of patients is known as credentialing.

Each payer has its credentialing requirements, so don’t make the mistake of assuming you don’t need credentialing. Having payer contracts isn’t enough unless you have facility contracts. You must ensure that your providers are connected to your practice’s payers for claims to be processed correctly.

Accidentally committing “locum fraud”

Clinics frequently have questions about how to properly bill for outside providers who are working at their facility temporarily. Just because a mid-level provider or nurse practitioner works for a locum agency doesn’t mean they can be reimbursed under the locum rules.

 A locum tenens physician is a doctor who fills in for another doctor temporarily. Because mid-level providers are paid 15% less than physicians by some payers, such as Medicare, billing a mid-level provider under a physician is not only inappropriate, but it also risks the payer reimbursing you for more than they should.

Missing steps at the front desk

Is your staff asking all of the appropriate questions when a new or returning patient walks through the door? If you don’t confirm a patient’s current insurance information before they leave your clinic, your chances of getting this information later are slim.

When you don’t have insurance, you’re less likely to get paid in full. It takes time to follow up with patients to obtain missing information, and patients are unlikely to respond quickly. This can stymie your claims process and, as a result, your reimbursement.

Incorrect documentation

In an incredible urgent care facility, the quality of an EMR is only as good as the provider who uses it. Clinic revenue can be affected if providers aren’t documenting all of the services they provide, capturing ancillary services, and using the correct modifiers in the correct section of the EMR. To make sure that your claims are clean, billers should have a thorough understanding of payer guidelines.

Having a coding specialist in staff, whose job it is to check and verify codes before they are submitted, can go a long way toward reducing errors. As a result, ensuring that you are paid correctly for the services you provide.

Incorrectly filling out the claim

In urgent care billing, filling out a claim can be a confusing process. Omitting important information or including unnecessary information can result in a claim being denied.

Sunknowledge is the most comprehensive urgent care billing solution available.

In this situation, Sunknowledge can help you get your claims paid and minimize your losses. Our proactive and streamlined revenue cycle management process ensures a consistent flow of cash into your business while also giving you complete visibility and assurance of your payments at every stage of the urgent care billing process.

Where others fail, Sunknowledge succeeds:

  • We provide complete Urgent Care Billing and Support for only 2.9% of all collections.
  • Hands-on assistance is provided.
  • Any price can be matched or surpassed.
  • Reputable industry references.
  • While working on all 7 days of the week, our team assures all Urgent Care Centers that there will be no backlog.

We offer hands-on assistance with CPC-certified coders and an urgent care billing team that comprehend what it takes to recover your cash flow. We can promise you that no one can match our flexibility and dependable consistency. We also offer a $3 million insurance policy that covers any computer hacking.

Hence to conclude, correcting these urgent care billing errors can result in significant revenue increases for your facility. Not sure if your center is making these mistakes or need help correcting them? Consult with a professional urgent care billing company like Sunknowledge that specializes in urgent care revenue cycle management.