Understanding Urgent Care Centers

Urgent Care centers are medical facilities for walk-in treatment for acute but non-life conditions. Urgent care centers are designed to bridge the gap between routine primary care and emergency services. Urgent Care centers can be categorized based on their treatments such as-

  • Acute Infections
  • Minor Injuries
  • Preventive Care
  • Women’s Health
  • Travel Medicine
  • Minor Procedures
  • Diagnostic Services

Introduction to Urgent Care Billing Services

Urgent Care billing service caters to help the difficulties such us continuous coding modifications and payer-specific billing requirements, moving reimbursement speeds between commercial payers, Medicare, and Medicaid, increased claim denials due to insufficient documentation and coding errors, and time-exposed billing demands needing immediate insurance verification and claims processing.

At RevPro, we provide accurate coding, clean claim submissions, and faster reimbursements with our expert urgent care revenue cycle management (RCM) services.

Key Billing Elements in Urgent Care-

Evaluation and Management (E/M) CPT codes-
  • 99201-99205: New patient visits.
  • 99211-99215: Established patient visits.
CPT Codes:
  • Wound repairs (12001-13160)
  • Splinting and casting (29000-29799)
  • Injection and Infusion codes (96372, 96374, etc.)
HCPCS Level II Codes-
  • S9083- represents a flat fee for urgent care services.
  • S9088: used in conjunction with E/M codes for services provided in an urgent care center.
ICD-10 Codes-
  • S00-S99: This entire section covers injuries
  • J06.9: Acute upper respiratory infection, unspecified.
Modifiers-
  • 25- Used to indicate a significant, separately identifiable E/M service performed on the same day as a procedure.
  • 59- Used to indicate a distinct procedural service. This is used when procedures that are normally bundled are performed separately.

Common Challenges in Urgent Care Billing

Urgent care billing has some unusual challenges that affect reimbursements, compliance, and cash flow management.

  • Coding Complexities- To bridge the gap between Primary Care and Emergency Room, Urgent care caters a wide range of conditions, from minor injuries to acute illnesses. This requires proficiency in a broad spectrum of CPT, HCPCS, and ICD-10 codes.
  • Front-Desk Challenges- Due to volume of patients, urgent care environment demands quick patient registration and insurance verification, which can lead to rushed documentation.
  • Payer Variations: Urgent care centers encounter patients with various insurance plans, each with its own coding and reimbursement policies.

With RevPro’s specialized Urgent Care Billing services, we train our team with the changing regulations of payer guidelines and also the complexities of the coding system.

Get in Touch

Need urgent care billing specialist?

Get in touch with us today to connect with our expert advisor to decrease claim denials, improve reimbursements, and simplify your RCM.

Schedule a Call today!

Benefits of our Expert Urgent Care Billing Services

Our specialized urgent care billing service ensures reduced administrative burdens, increased reimbursements and minimum errors —empowering you to focus entirely on patient care.

Clean Claim Submission

>95% 1st-pass claim acceptance rate.

Cost Advantage

>70% reduced operating expenses.

Improve AR Cycle

<32 days of avg. AR Cycle.

Excellent AR Management Efficiency

>30% Reduced AR bucket in a month.

Coding Expertise

>99% coding accuracy.

Compliance

100% HIPAA compliant

Our specialized Urgent Care Billing Services

At RevPro, we offer end-to end billing support customized for urgent care centers, delivering efficiency, accuracy and peace.

Patient Registration
and
Insurance Verification:

Patient Intake:
  • Gather patient demographics (name, address, date of birth)..
  • Obtain insurance information (primary and secondary).
  • Collect the patient's reason for the visit.
Insurance Verification:
  • Verify insurance eligibility and benefits in real-time.
  • Check for co-pays, deductibles, and covered services.

Patient Encounter
and
Documentation

Clinical Services:
  • Healthcare providers deliver medical services.
  • Accurate and detailed documentation of the encounter is vital.
Documentation
  • Capture patient's complaint, medical history, examination findings, diagnosis, and treatment plan.
  • This documentation supports the codes used for billing.

Medical Coding

Diagnosis Coding (ICD-10):
  • Assign appropriate ICD-10 codes to reflect the patient's diagnoses.
Procedure Coding (CPT/HCPCS):
  • Assign CPT codes for procedures performed and E/M codes for patient visits.
  • Use HCPCS "S" codes when applicable, keeping payer specifications in mind.
  • Apply modifiers when necessary (e.g., modifier 25, 59).
Coding Accuracy:
  • Ensure coding accuracy to prevent claim denials.
  • Stay updated on coding changes and guidelines.

Charge Entry:

Enter Coded Services:
  • Enter the coded services into the practice management system.
  • Match codes with corresponding fees.
  • Add any applicable modifiers.
Calculate Charges:
  • Calculate the total charges for the patient encounter.

Claim Generation
and
Submission:

Generate Claims:
  • Create electronic claims containing patient demographics, insurance information, diagnosis codes, procedure codes, and charges.
Claim Submission:
  • Submit claims to insurance payer’s system.
  • Ensure claims are submitted promptly.

Payment Posting
and
Reconciliation

Payment Posting
  • Process payments and post payments promptly upon receipt
  • Allocate payments to the correct patient accounts and claims
Reconciliation
  • Reconciling payments with submitted claims and compare payments to expected reimbursement
  • Identify and investigate any discrepancies
  • Update patient accounts with insurance and patient payments

Patient Billing
and
Patient Responsibility:

  • Generate Patient Statements: Create and send patient statements for any remaining balances.
  • This could include deductibles, co-pays, co-insurance, or services not covered by insurance.
  • Collect Patient Payments: Collect patient payments through various methods.
  • Address Patient Inquiries: Respond to patient inquiries regarding billing and payments.

Handling Partial Payments, Adjustments-

  • Determine reasons for partial payments and apply contractual adjustments accurately
  • Identify need for appeals or additional billing to patients
  • Follow-up on Unpaid Claims

Tracking Claim Status

  • Implement a system to monitor unpaid claims
  • Set timelines for follow-up based on payer guidelines
  • Utilize payer portals and electronic claim status inquiries

Addressing Claim Rejections
and
Denials

  • Identify root causes of rejections and denials
  • Correct and resubmit rejected claims promptly
  • Develop a systematic approach to appeal denials

Resubmission
and
Appeal Processes

  • Understand timely filing limits for resubmissions
  • Gather additional documentation for appeals
  • Follow payer-specific appeal procedures.

Why choose RevPro for Urgent Care Billing Services?

We are committed to adding value with our Urgent Care billing experts, we ensure you productivity so that you can provide your patient what they deserve the most- best care.

  • Experience- Our expert urgent care billers comes with 3+years of experience.
  • Expertise- Our billers are accustomed with all major billing platforms to ensure productivity.
  • Compliance- We are ISO certified and HIPAA compliant and dedicated to secure PHI.
  • Exclusive Model- We allow you to choose any section of your billing system and deliver.
  • Scalability- We have a huge pool of professionals, we grow with you!
  • Flexibility- We are flexible with our pricing and contract terms, ensuring peace!

Get in Touch

Need urgent care billing specialist?

Get in touch with us today to connect with our expert advisor to decrease claim denials, improve reimbursements, and simplify your RCM.

Get a Free Consultation