Urgent care facilities continue to expand rapidly as the healthcare landscape changes. Their capacity to deliver speedy, inexpensive, and effective medical care is what fuels their popularity.
Private insurance claim lines for treatments provided in urgent care are long due to the booming demand for urgent care.
Even though the urgent care industry is seeing tremendous growth, billing and coding errors could cause urgent care facilities to lose a lot of money. Making billing and coding errors might mean the difference between a center’s success or failure for more than simply a few pennies.
Here are the top five urgent care billing and coding errors, along with explanations of how to avoid them in the future.
Ineffective front desk procedures not being fixed
The front desk is where your healthcare revenue cycle solutions begins, and urgent care clinics frequently make the error of neglecting to implement effective financial procedures that start at their front desks. Make sure to collect co-pays at the beginning of patient visits rather than delaying this payment until the end.
Prior to providing patients with new services, outstanding balances must be recovered. Lack of effective front desk procedures can lead to an increase in bad debt, missed earnings, and patient accounts that go into collections.
Establish front-of-the-house financing procedures for your urgent care center. Retrain staff employees on a regular basis to make sure everyone is current and using these procedures.
Bad contracts already in place
When you set up your contracts with payers, you must sign a contract with them committing them to pay your facility according to the fee schedule you agreed upon and to promote your facility as an in-network center in their network directory.
It will be difficult to increase patient volume if you don’t have contracts with payers because you won’t be able to accept insurance.
Since contracts with low reimbursement rates indicate you aren’t getting reimbursed too much for the services you are providing patients, negotiating lousy contracts might be almost as harmful as not having any contracts. Negotiated reimbursement rates must be reasonable and represent the entire range of services your urgent care center offers.
Failure to Comply with Credentialing Requirements
Credentialing and contracting are not the same thing, and the processes are extremely different. This is vital to grasp. Credentialing is the procedure a payer uses to confirm a provider’s knowledge, experience, and credentials in order to guarantee patient safety.
Don’t make the costly assumption that each payer’s criteria are the same as each other because each payer has different credentialing needs.
Lack of timing, bad organization, poor workflow, failing to maintain contact information up to date, and neglecting to check for state compliance are just a few of the credentialing issues that many medical facilities encounter when going through the procedure.
The easiest option to correct this error is to work with credentialing specialists who can help you understand the specific payer’s credentialing requirements.
Incorrect documentation or inadequately coded charts
Even with a fantastic electronic medical records system for your urgent care, your EMR is only as good as the doctors that use it. Accidental under-coding might occur as a result of improper item documentation, costing the facility a lot of money.
In order for office visit codes to appropriately reflect what was done during the appointment, providers must also ensure that they are accurately documenting exams, histories, and MDM corrections inside the EMR system.
It is crucial to endeavor to ensure that urgent care providers are fully informed on how to use the facility’s EMR system because providers specialize in treating patients, not coding. Periodically, refresher classes could be beneficial as well.
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Missing Important Charges
Missing out on important charges can cost your urgent care a lot of money, and insufficient documentation is frequently to blame. Patient visits can be so hectic that it’s simple to overlook recording a step, especially if instructions have been given verbally. X-rays, interpreting findings, injections, blood samples, and labs are a few of the most frequently overlooked expenditures.
Additionally, healthcare professionals could neglect to record prescription dosage amounts. It is important to accurately record the quantity of medications dispersed so that payer claims can reflect the appropriate charges. Poor visit documentation will cause claim submission delays or claim denials.
Your EHR systems intelligent alerts can deliver reminders when providers are locking charts.
Making Errors Claim Form Filling
Another significant urgent care billing and coding error you must avoid is making mistakes when filling out claims. Filling out claims can be difficult, and doing so runs the risk of them being denied if extraneous or critical material is left off.
Your claim may be denied if you forget to include code modifiers or if you use the incorrect modifiers.
Suggestions for Increasing Urgent Care Revenue
Although the healthcare industry is necessary as it plays a major role in keeping well and restoring others to full health, it is also a business.
In order for wellness centers to continue operating and helping the sick, it is crucial that they take the required steps to ensure their financial success. Here are four suggestions for increasing revenue for urgent care centers.
Revenue Cycle Management
Improving your revenue cycle management is the first and best advice for increasing urgent care income. This might require more front desk training.
It includes crucial components like making sure to greet every visitor and verifying that each patient’s insurance is in effect.
Technology usage
Healthcare has benefited greatly from technology, which also makes the process of collecting payments much more streamlined and simple. Online scheduling can, on the one hand, assist manage and streamline processes in your business.
On the other hand, you can make use of applications that speed up patient responses and payment calculations. Through the use of systems like electronic fund transfers, technology also increases the efficiency of payment processing.
The idea of telemedicine is steadily gaining acceptance. It enables urgent care centers to reach out to patients who are unable to physically enter the institution.
Increased Hours
It is extremely hard for people to take time off and come in for an appointment because the majority of them work during the day. Increased accessibility will allow more patients to visit the office after or even before work.
By allowing more people to schedule appointments, you’ll increase revenue.
The Influence of Negotiation
It’s not only about the patients when it comes to increasing revenue. Everything is negotiable, even the costs of non-fixed expenses like cleaning services, office supplies, marketing, building leases, and other things.
Best Practices For Billing In Urgent Care Centers
Even yet, an urgent care facility cannot afford to make expensive billing errors if they want to succeed. These errors not only cost the center money, but they also give the institution a bad reputation. Let’s examine some of the ideal methods for billing at urgent care facilities.
When submitting claims, be accurate.
When businesses submit claims, errors are a major problem. A refusal may result if not all required information is provided. Common errors include omitting or using the incorrect code modifiers, not defining the code clearly, and writing legibly.
Prioritizing The Front-End
The revenue cycle process takes a long time. It starts when a patient approaches your front desk. For this reason, you need to make sure that your front-end operations are functioning properly. Without the proper front-end processes, your center is setting itself up for revenue loss. Your front-desk workers should always be aware of the expectations for them.
