Urgent care billing will cost your center more than just a few cents off the dollar if you make errors. They can be quite expensive, sometimes even at the cost of your center’s success.
The urgency of any condition that has to be treated sets urgent care except primary and emergency care. The term urgent care describes treatment required for a problem in less than 12 hours, but not an emergency. In addition, the costs of urgent care are very different from those of general and emergency care and lie between the two. Many individuals visit an urgent care center because there is rarely a wait. Due to this tendency, more patients seek urgent care, which has raised revenue for the company. Market analysts predict urgent care billing services will reach $26 billion globally by 2023.
The 7 Worst Urgent Care Billing Mistakes
The following are the seven most significant urgent care billing and Coding errors you most likely aren’t even aware of committing:
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Negligent Contract Negotiations or No Contracts at All
By entering into contracts with payers, you formally request that they promote your urgent care facility as in-network in their network directory and pay you according to the agreed-upon fee schedule. Before opening your urgent care facility, you must establish agreements with payers in your area in order to accept insurance. The patient volume you need to break even is tough to increase because of the urgent care billing error.
Payers who negotiate low reimbursement rates will not pay you much for the services you provide to patients. The contracted fees must be fair and consider the variety of services your urgent care facility offers.
Hire a contractual expert to negotiate your payer contracts as a fix. An expert in contracting will be aware of the most satisfactory reimbursement rates in your region and ensure you stay clear of costly errors and delays.
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Breaking The Rules for Obtaining Credentials
Contrary to popular belief, contracting and credentialing are two quite distinct procedures. A payer validates a provider’s experience, knowledge, and credentials through credentialing in order to protect patients. Don’t assume that credentialing is unnecessary just because one payer didn’t demand it because each payer has different criteria. Even having payer contracts is insufficient if you don’t also have facility contracts. To ensure that claims are correctly processed, you must ensure that your providers are connected to the payers for your practice.
How to solve it: Employ the services of a credentialing specialist who can guide you through the criteria for payor accreditation.
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Unintentionally Engaging In “Locum Fraud”
Clinics frequently have concerns about correctly billing outside providers who are only temporarily working at their facility. A nurse practitioner or midlevel provider’s affiliation with a locum agency does not automatically entitle them to bill under the locum rules. Locum tenens is, by definition, a doctor who fills in for another physician. It is not only illegal to bill a mid-level provider under a physician but doing so might result in the payer reimbursing you more than they should for the service than is appropriate. For example, Medicare pays mid-level providers 15% less than physicians. You would also be scamming individuals.
Only bill physicians as locum tenens; that’s how you correct it.
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Steps Missing at The Front Desk
The cycle of Urgent Care billing starts at the front door. When a new or existing patient enters the building, are your staff members asking them all the pertinent questions? A patient has a significantly lower chance of presenting you with their most recent insurance information if you haven’t done so before they leave your clinic. Reduced chances of receiving a complete payment result from not assuring coverage and failing to collect copays. It takes time to follow up with patients to obtain missing information, and they are unlikely to be in a rush to do so. This might delay the processing of your claims and, eventually, your receipt of payment.
Choose a PM system that delivers real-time insurance verifications to help you see potential billing problems before they occur. Furthermore, always take a copay at registration. Before sending any documentation to the billing department, be sure it is accurate.
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Lacking Knowledge Of (And Adherence To) The 2022 E/M Guidelines
The years 2021 and 2022 saw significant changes in E/M coding and regulatory updates. To assist clinics in managing COVID-19 testing, telehealth visits, and vaccine delivery during the pandemic, new CPT codes were developed. Additionally, in order to help providers, the E/M coding rules underwent a significant revision in January 2022. You can lose money if your staff is not educated about coding in light of the changes. Additionally, the accuracy of your claims might require rework and postponed reimbursement.
Establish solid financial procedures at your front desk, and train your staff on them. Organized re-training to ensure these processes follows regularly.
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Inaccurate Documentation
Excellent urgent care Billing EMR is only as effective as the provider utilizing it. Lower clinic revenue may result in clinicians failing to document their services, capture ancillary services, and use the appropriate modifiers in the EMR section. Billers need to be well-versed with payer policies to ensure your claims are accurate. In order to reduce errors and eventually receive proper reimbursement for the services you give, hire a coding specialist whose duty is to examine and validate Urgent care codes before they send for submission.
How to fix it: Since providers attended medical school to learn how to treat patients rather than how to code. Alternatively, your chief medical officer and office manager should collaborate with your billers or an urgent care billing service. Furthermore, developing a quality assurance procedure ensures that healthcare professionals receive proper training and retraining to utilize the EMR.
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Incorrectly Filling the Claim Form
It may be unclear to fill out a claim, and leaving out important information and adding extraneous details might result in a claim being rejected. For instance, certain payors need a specific format for the National Drug Code (NDC) entry in the medical record. While some payors do not require the NDC, they will reject a claim if it is submitted in a format that is not the payor’s preferred format. Confused? It’s not merely you.
How to correct it: In order to avoid claim denials, a skilled urgent care billing agency will be able to manage the complexities of claim filing.
WHY CHOOSE NEO MD FOR URGENT CARE BILLING?
The tasks involved in medical billing and coding can be challenging. Therefore, handling these processes internally might not be a good move from an economic or strategic standpoint. Another difficult issue for medical facilities is keeping up with the rules and regulations that are constantly changing. Due to the industry’s quick evolution, urgent care medical billing and other emergency room coding are peculiar.
Our dedicated team of medical billers and coders can assist you in expanding your practice. Our team follows all Medicare Urgent Care Billing and Coding regulations to ensure maximum reimbursement. Real-time, quick, precise, error-free coding of each claim and an early examination to ensure claim eligibility reduces the risk of claim denial and refusal. Top US revenue cycle management companies supervise many newly built healthcare facilities. Very few medical billing companies probably don’t have their services accepted by healthcare organizations.
Across every state in the US, NEO MD Medical Billing has been collaborating with various urgent care centers. With over 15 years of experience in urgent care billing and emergency departments, we have developed distinctive solutions that have rocked the Revenue Cycle Management industry.
The Urgent Care Billing services provided by NEO MD are frequently rated as the finest in the US compared to other Revenue Cycle Management companies. NEO MD also provides medical billing services for small, medium-sized, and large practices. Additionally, we provide practices in all US states with specialized billing services. So, for acquiring services, the healthcare facilities find us the best Medical Billing company near me.
What Makes NEO MD the Best Urgent Care Services Company?
NEO MD stood best among competitors in terms of providing good Revenue Cycle Management services to practices due to the following cores;
- Our experts work hard to reduce your front-end denials by 20%.
- Identify potential under, over, and incorrect coding scenarios
- Provide fortnightly financial and practice overviews
- Offer Provider & Staff Productivity Analysis
- Out of Network Negotiations.
- Use the latest technology and tools to ensure the accuracy of claims and faster collection.
- Offer internal Medical Billing audits to uncover loopholes
- Refunds adjustment and Payment posting to improve the cash flow.
- Improve RCM system efficiency with a robust credentialing team.
- Offer Services that are easily scalable at all times
- We have consistently increased the collection rate (Urgent Care Billing) for our clients
Let’s schedule an appointment and discuss it in-depth with Medical Billing and Coding specialists. Contact us now at ([email protected]) or (929) 502-3636).
for more info: https://neomdinc.com/urgent-care-billing-a-thorough-billing-coding-guidelines/
