Urgent care centers operate smoothly through a steady flow of cash that is required to maintain the continuity of core processes. Without timely cash flow, the urgency in delivering care and services to patients is affected. If cash flow slows, difficulties arise when scheduling, staffing, and managing a supply chain. Many urgent care centers are constantly facing billing challenges that prolong payment.
Insufficient documentation, inaccurate bill submissions and many other obstacles obstruct the payment process. These challenges add up to increase accounts receivable, which becomes a financial burden. For urgent care providers that operate on speed, quality, and having an established patient trust, billing-related delays and challenges can be especially frustrating.
What is Urgent Care Billing
Billing for urgent care services is complicated as the process includes verification of medical necessity, appropriate documentation and accurate claims submission. Additionally, the services include follow-up on pending claims, and managing accounts receivable. These require precision, compliance, and communication between the billing and clinical staff.
A minor error can cause payment delays or denial. For urgent care centers that count on being paid quickly, those delays cause immediate financial loss. Thus, an efficient billing process is crucial to being profitable and continuing to operate.
Challenges for Urgent Care Billing
Although urgent care centers seem to provide quick and efficient medical care, there exists a tremendous amount of administrative pressure. Billing experts face the unique challenges that are often associated with lost revenue and added workload.
Collecting Accurate Patient Demographics
Urgent care patient intake requires speed, which increases the chance for human error in the form of misspelled names, or just missing and redundant information. These can create claim denials and the frustration of having to clean them up through another administrative effort.
Digital intake forms help remove the chance for errors from the outset before claims are submitted. Clean and accurate demographic information is imperative to ensure claims incur no issues the first time they are processed.
Insurance Verification
When a patient has received treatment prior to confirming their eligibility for coverage, it can often lead to a wrongful denial. The eligibility check verifies coverage details, deductibles and co-pays and helps avoid unwanted surprises thereby ensuring accurate billing.
Accurate Coding
One of the greatest challenges of urgent care billing is the difficulty of maintaining accuracy in coding. There may be limited resources, which can cause the coding expert to incorrectly enter the CPT code or a modifier that simply does not match what the attending provider specified. Billing mistakes become compounded when there is an outdated codebook or if a payer makes a change that is missed. Even one billing mistake can cause claims to be denied, require further work, and decrease revenue.
Certified coding professionals continuously monitor payer guidelines and review each claim before submission. As a result, it improves accuracy and minimizes denials.
Denial Management Challenges
Denied claims are time-consuming and lead to backlogs. Missed diagnosis codes, documentation clarifications, or medical necessity issues lead to delays in payment. Busy internal teams face backlogs on appeals, further delaying and imposing cash flow challenges.
When reviewed systematically and timely, denials do not happen, and payments come in more quickly.
Delayed Patient Payments
Timely collection of payments is critical in an urgent care setting. Irregular reminders, non-operational portals or no digital payment options delay payment.
Updating the payment process, ease of the payment portal, or ability to pay at the point of service allows centers to operate more quickly and allows staff to focus time on more valuable work.
Keeping Up With New Rules and Regulations
Urgent care billing can be complicated because it requires the experts to stay up-to-date of the latest CMS requirements, changes in payer policy, and new regulations. Non-compliance leads to audits, resulting in payment delays, and loss of reimbursement.
A billing team should watch out for regulatory updates and help keep providers compliant and prevent payment collection drag. Outsourcing medical billing and coding can offer enhanced revenue growth.
Why Outsource Urgent Care Billing
Outsourcing is a viable alternative for an increasing number of urgent care centers. These businesses utilize specialized providers who have the knowledge of current coding practices, and regulations associated with reimbursements. It keeps errors to a minimum while helping with efficient revenue cycle management and compliance. This allows practices to spend time on non-billing-related duties.
Outsourcing can mean significantly fewer costs when considering recruiting and training an in-house billing department. New software and processes help the provider work more efficiently; allowing claims to move through the billing process faster and more accurately when billing departments are outsourced.
By outsourcing, practices can save up to 80% in operational costs with hourly rate as low as $7. It helps urgent care providers to concentrate on caring for their patients. This helps healthcare practices reduce administrative burden and concentrate more on patient care.
