Urgent Care Billing: A Thorough Billing & Coding Guidelines

Urgent Care centers are expanding rapidly as the healthcare industry continues to evolve. Their capacity to deliver speedy, inexpensive, and effective medical treatment is what drives their popularity. At the same time, due to unpredictable fluctuations in patient flow coupled with the fast-paced environment, Urgent Care Billing is more complex than other Medical Billing scenarios.

The significant way that Urgent Care differs from primary and emergency care is in the urgency of any condition that must be treated. Urgent Care refers to any essential treatment within 12 hours for conditions like fever or minor injuries but does not come in the remit of emergency. Aside from this, Urgent Care expenses differ significantly from those of general and emergency care and fall in the middle of the two. Because there is seldom a wait, many people decide to go to Urgent Care. This tendency has increased the volume of patients seeking Urgent Care, raising the company’s revenue. An estimated $26 billion will be spent on Urgent Care Billing services globally by 2023.

Table of Contents

What Is Urgent Care Billing?

It involves the entire claims-filing procedure, including checking that all supporting documentation is in order and that medical necessity exists. Additionally, it’s crucial to follow up on claims, make adjustments, adhere to filing deadlines, and do A/R collections when it concerns Urgent Care Billing.

Urgent Care Billing; An Overview 

A consistent cash flow within the company is the lifeline of every business. Among other things, it ensures the regular availability of funds needed to sustain the continuity of key procedures. In other words, it supports a business and provides the energy it needs to keep running efficiently.

Unfortunately, problems with delayed payments, inefficiency, and accumulating account receivables exist in the realistic scenario. Rejections, denials, and situations involving incorrect billing or faulty bills exacerbate the problem. It’s no wonder that receiving payment for services frequently becomes a nightmare.

This is a sorry state of affairs for Urgent Care centers.

How Does the Urgent Care Billing Process Work?

Urgent Care clinics bridge the gap between primary care physicians and emergency rooms, a critical function of these facilities in our healthcare system.  You must recognize the fundamentals of billing and how to optimize your processes for maximum returns if you want to command your fair share of the market.

Front Desk; The Urgent Care Billing Kick-off

The cycle of billing for Urgent Care starts at the front door. You may improve your revenue and spend less on costly collection procedures by establishing sound financial regulations that start at check-in.

Due to the walk-in nature of appointments, Urgent Care clinics often do not have a pre-registration process. However, when a patient requests an appointment, the front desk employee or receptionist must collect some basic data for billing purposes.

Important details include:

Ideally, data collected during registration will make it easier to create an electronic health record (EHR). Providers and support staff will collaborate within the EHR to create patient notes, record medical histories, propose treatments, and more. An updated patient record with in-depth notes significantly streamlines the billing processes. It’s crucial to record any demographic or insurance information about a patient at each appointment if they often come.

Determine Financial Responsibility

A walk-in clinic sometimes lacks time to call insurance providers and get pre-authorization for services. Patients should be aware of the details of their insurance plan and the costs they might anticipate from a walk-in facility. Each patient must sign an affidavit of financial responsibility before obtaining medical treatment in order to prevent any potential billing disputes.

Post-Visit Follow Up

All procedures and pertinent data should be entered into the EHR as soon as a patient receives services from a doctor or other provider. This aids in the preparation of an accurate bill to make the claim generation and patient balance collection simpler.

Submission of the Claim

Sending the bill to the payer followed each medical procedure’s correct coding and regulatory compliance review as the last step in the billing process. The insurance company’s bill contains all the pertinent details on the diagnosis, procedures, and associated costs. An accurate bill promotes a quick reimbursement process, encouraging prompt payment of your reimbursement claims as the healthcare provider.

The majority of medical practices file claims electronically since it is the most precise and quick way to be reimbursed. Generally, medical software helps in the recording of patient information and the creation of claims for reimbursement.

Urgent Care Billing
Urgent Care Billing

Urgent Care Billing and Coding Guidelines

There aren’t many distinctions in the billing processes between Urgent Care and primary care because the problems treated by both are identical. There are, however, a few medical codes that apply specifically to Urgent Care Billing. These codes begin with an “S.” Billing for Urgent Care settings use codes that start with an “S.”

For billing purposes, there are two basic code groups that apply to all Urgent Care except Medicare.

S9088, also known as “services provided in an Urgent Care center (list in addition to code for service),” permits Urgent Care facilities to bill for the diagnosis and treatment of medical issues while acknowledging the services given in an Urgent Care facility are intrinsically more expensive. The S9088 code cannot be used in isolation; it must be used along with the proper evaluation and management (E/M) code. The Urgent care billing code S9088 allows centers to receive reimbursement for at least a portion of the increased cost of providing immediate care.

S9083 – Allows Urgent Care to impose a single service cost regardless of the patient’s course of care. In some circumstances, a managed care organization (MCO) will demand that a hospital bill using the S9083 Urgent care billing code. In fact, several MCOs in states like Florida and Arizona demand that Urgent Cares bill all services under S9083.

Urgent Care’s Most Common CPT Codes

In Urgent Care centers, E/M codes make up the bulk of CPT codes. Some of the most common CPT codes used in an Urgent Care setting are:

CPT Code 99214

The AMA states that the diagnosis code 99214 is for “office or other outpatient visits for the evaluation and management of an established patient, which require at least two of these three key components: a detailed history, a detailed examination, and medical decision-making of moderate complexity.”

CPT Code 99213

The CPT code 99213 is for an existing patient who needs care but is not as complicated as code 99214. Because it is simpler to meet the requirements for reimbursement, it is one of the most often used codes. However, it frequently reimburses less than 99214.

CPT Code 99204

One of the most often utilized codes for new patients in an Urgent Care setting.  It requires fulfillment of three key criteria: a thorough history, comprehensive review, and moderately complex medical decision-making. It has a comparatively high reimbursement rate with a correspondingly low risk of noncompliance.

The majority of Urgent Care Medical Billing CPT codes lie between 99202-99205 and 99211-99215, according to CPT assistant, which offers billers and coders industry-recognized guidelines. Remember that billing with ER-designated CPT codes is not permitted since Urgent Cares bridge the gap between a primary care office and an emergency department and poses a compliance risk.

Challenges in Urgent Care Billing

Due to advancements in ICD 10 and CPT Codes, it is difficult for practices to comply with all Medical Billing and coding rules & regulations. The best way to get rid of all these is to outsource Medical Billing to a reputed Medical Billing and coding services company.

NEO MD Medical Billing has been collaborating with various Urgent Care centers across all the states of the US. We have more than 15 years of Emergency Room Billing/Urgent Care experience and unique strategies that stimulated several-trembling Revenue Cycle Management. Furthermore, our experts discovered loopholes and placed the practice’s Urgent Care Billing as the most profitable department. Outsourcing Medical Billing to NEO MD will prove a good decision as our billers and coders are already excelling in the field. 

Despite the fact that Urgent Care and primary care share many coding standards, it is up to the coder to choose the Urgent Care billing codes that are most relevant for a given medical treatment while also ensuring that the codes adhere to regulatory requirements. Urgent Care bills must also adhere to certain insurance company regulations before filing a claim. Urgent Care claims are likely rejected if they don’t comply with this requirement.

Most Urgent Care centers lack the time to verify the patient’s insurance coverage due to the issue’s urgency. The probability of a claim being denied due to lack of coverage increases if you don’t get pre-authorization from your insurance carrier for any medical services.

Centers for Medicare and Medicaid (CMS) are responsible for setting reimbursement rates by Medicare for medical services.  The new Medicare physician pricing schedule, which CMS announced in 2022, indicates lower compensation for all Urgent Care and emergency medical services.

Medicare does not cover the increased costs of medical services provided in Urgent Care settings, despite paying over 80% of Urgent Care expenses. Medicare typically pays for Urgent Care services in a range that is comparable to that of primary care services. Most Urgent Care centers accept Medicare, although private insurance may be more profitable in terms of compensation.

Urgent Care Billing
Urgent Care Billing

How Can NEO MD handle the Urgent Care Billing for Centers / Practices?

The tasks associated with Medical Billing and coding may be exceptionally demanding. Therefore, it might not be a good idea to handle these procedures internally from an economic or strategic perspective. Maintaining compliance with the rules and regulations that are constantly changing is another difficult task for physician facilities. Coding for Urgent Care Medical Billing and other Emergency Room is peculiar because the industry is rapidly evolving.

Our devoted staff of medical billers and coders can assist you in expanding your company. Our crew monitors all Medicare Urgent Care Billing guidelines to maximize reimbursement. Reduced risk of claim denial and refusal comes from real-time, speedy, accurate, error-free coding of each claim and an early evaluation to assure claim eligibility. Many emerging healthcare facilities operate under the auspices of top Revenue Cycle Management companies in the US. Very few Medical Billing companies likely do not have their services recognized by healthcare providers.

Compared to other Revenue Cycle Management companies, NEO MD’s Urgent Care Billing services are consistently ranked as the best in the US. Additionally, NEO MD offers Medical Billing services for small practices, medium, and large practices as well. Furthermore, we provide customized billing services to practices across the US states. So, for acquiring services, the healthcare facilities find us the best Medical Billing company near me or you can simply search https://neomdinc.com/.

What Makes NEO MD the Best Urgent Care Services Company?

NEO MD stood best among competitors in terms of providing good Revenue Cycle Management services to practices due to the following cores;

FAQ:

What Is Urgent Care Billing?

It involves the entire claims-filing procedure, including checking that all supporting documentation is in order and that medical necessity exists. Additionally, it’s crucial to follow up on claims, make adjustments, adhere to filing deadlines, and do A/R collections when it concerns Urgent Care Billing.

How do you code urgent care?

It is only appropriate to use the HCPCS code S9088, “Services provided in an urgent care center (list in addition to code for service)” in an urgent-care center. This code would be billed for each visit.

What is procedure code S9083?

Payors utilize Code S9083 to group all services provided during an urgent care visit, whether for a hangnail or a heart attack, into a single, universal global code for payment at the same holistic flat-rate rate.

Does urgent care require authorization?

Authorization must be obtained the same day in cases of emergency (i.e., those requiring immediate care and treatment to prevent risking the individual’s life or health or causing injury to another person by the individual).

Why is authorization important in medical billing?

Prior Authorization in Medical Billing assists the healthcare organization in the proper payment collection for the services delivered, decreasing denials and follow-up on the same.

What are the limitations of urgent care?

The drawback of urgent care centers is that they do not have the same resources as an emergency room to deal with life-threatening conditions. The fact that you most likely won’t see the same doctor each time you go to the clinic might also be a disadvantage.

What Are the Coding Guidelines in Urgent Care Billing?

A coder typically transforms all the procedure and diagnostic specifics into the medical code sets after the patient encounter is over. The management and assessment of the disease, surgery, imaging, anesthesia, pathology, medicine, and lab tests, among other things, are all covered by an urgent care center’s CPT code.

What are the advantages of urgent care?

The Top 5 Benefits of Urgent Care
– Urgent care facilities have better hours than your doctor’s office.
– Urgent care offers quicker service than an ER and may even be faster than your doctor’s office. 
– Urgent care will save you money.
– No appointments are necessary.

Urgent Care Billing
Urgent Care Billing



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