3 Common Mistakes With Urgent Care Billing

Medical claim denial rates reached 11% in 2016, after a steady increase year after year. These denials are a result of billing mistakes. And those mistakes put a strain on the operating revenue of urgent care facilities. 

If you’re concerned about how these billing errors could affect your business, this article’s for you. Continue reading to learn about common urgent care billing mistakes plaguing medical clinics. You’ll also find suggestions on how to avoid these billing issues before they harm your business.

1. Front Desk Process Gaps

The collection of patient information starts at the front desk. Office staff must gather complete and accurate insurance data. Doing so helps to avoid medical billing issues.

The front desk staff is also responsible for collecting patient co-pays at the time of service.

For advice on the best process for engaging patients, read this guide from Med USA.

When a patient approaches the front desk, personnel should request insurance information. After verifying coverage, staff should then collect all current and past-due service payments. Otherwise, patients may leave without paying for their office visits.

Many individuals won’t return to provide payment. Nor will they respond to past-due billing notifications. This creates discrepancies for the urgent care billing department.

Front desk process gaps can result in a debt collection nightmare.

2. Incorrect Medical Coding

Providers must clearly document patient services according to Current Procedural Terminology. CPT codes get updated every year. So medical billing services using outdated software cause claim errors.

CPT errors create a backlog of denied claims for urgent care billing, and they can reduce revenue for the urgent care clinic.

Another common issue with urgent care billings is upcoding. Upcoding is the use of codes not relevant to the treatment provided. Not only is upcoding illegal, but it’s also unethical and costly to health insurance companies.

Creating an urgent care billing cheat sheet could help stop coding errors. They can include a list of codes common to urgent care services. Another option is to outsource medical billing and coding to consultants who specialize in these services.

3. Insufficient Contracts and Credentialing

Urgent care facilities must have contracts with insurance companies to receive reimbursement for services. Without these contracts in place, the clinic shouldn’t accept patient insurance, regardless of carrier. Urgent care clinics that don’t abide by the contracting rules can’t build the patient volume to cover expenses.

For this reason, clinics should hire a contracting expert. They can negotiate contracts with urgent care payers. They can also ensure the medical facility receives fair rates for services provided.

Another important factor is credentialing, during which payers verify each provider’s qualifications. It’s like facility contracts, except credentialing applies to each facility provider.

Each payer’s credentialing requirements may differ. So facilities must always confer with the insurance company. Insurance companies deny claims submitted for the services of providers without verified credentials.

Urgent Care Billing Mistakes

All these common urgent care billing mistakes can lower your clinic’s revenue. That’s why you should seek professional advice on running an urgent care facility. Developing an urgent care billing cheat sheet is a start. But outsourcing medical billing and coding may be a better solution.

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