How To Fix: Top Urgent Care Billing And Coding Mistakes

By Author: Richard Blake
Total Articles: 1
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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. In actuality, the majority of urgent care centers have wait times of 30 minutes or less, and the majority of appointments are an hour or less. 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.

How can this be fixed? Establish front-of-the-house financing procedures for your urgent care center. Make sure the people at the front desk are properly trained in your procedures. 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 billing 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. In order for claims to be processed properly, it is crucial to make sure that providers are authorized by payers.

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 (Master data management) 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.

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.

Once more, it's beneficial to train the staff at your urgent care facility to remember to record some of the most frequently overlooked fees. Your EHR systems intelligent alerts can deliver reminders when providers are locking charts. Drugs dispensed and requested labs should be recorded so that future comparisons with claim charges can be made with ease.

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. Illegible handwriting on forms, neglecting to include a crucial modifier, or failing to make a diagnosis code as specific as it should be are examples of other coding errors.