Urgent Care Billing Tips to Increase Revenue | XyberMed

Urgent Care Billing Tips to Increase Revenue

Emergency medical billing is about much more than coding and submitting claims - although performing these tasks correctly will certainly impact your bottom line. The medical billing cycle begins long before the claim form is submitted, and optimizing each step of the process will significantly increase overall revenue.

– Start Before You Encounter Patients

Insurers and government payers are notoriously picky when it comes to details, and one of the issues that urgent care facilities are sure to face is timing. Not only is it important to make sure the patient is insured at the time of the appointment/treatment, but also that your records are in order.

As an urgent care provider, you should make sure you are approved by all local payers and have appropriate contracts in place. While you are preparing all of this, be sure to negotiate the best possible rates. Some payers are not flexible, but it is worth asking insurers who can work with you for the best rates.

– Your Front Desk Plays a Key Role

Therefore, upon arrival of any patient, it should be standard procedure to obtain the insurance information necessary to apply for reimbursement and to correctly inform the patient of payments due and any future bills. Signing an affidavit of financial responsibility should also be standard procedure at the time of patient admission.

Although patients may not develop the same relationship with urgent care physicians as they do with their primary care physicians or specialists whom they see on a regular basis, they are likely to return to the facility in the future if they receive good medical care and are treated well by the staff. Building a customer base takes time and effort, and it is always more financially beneficial to have returning patients than to have to constantly recruit new "customers" to maintain cash flow.

Patients are your customers, and making them feel valued goes a long way toward building long-term relationships. In addition to compassion, this also means taking the time to clearly explain costs and being willing to negotiate with insurers when coverage is denied but the service in question is within the plan.

Maintain an Efficient Electronic Health Record (EHR) System

Running an effective urgent care clinic requires an efficient electronic health record (EHR) system. Just as in a hospital or primary care facility, the same patients are seen repeatedly in an emergency department. It is important to have complete, up-to-date records to provide the best possible care, and records are also an important part of medical billing. Complete records should be used as a reference in case there are problems with claim reimbursement.

Denied or denied claims must be tracked and appealed immediately. This reduces reimbursement time, which increases revenue, but perhaps more importantly, ensures that claims are not lost in the system and abandoned. Millions of dollars are lost each year because claims are dropped instead of addressing the problems that are the cause of nonpayment.

Keep Billers and Coders Current on Urgent Care Billing Changes

Not only are regulations constantly changing, but the codes themselves are updated annually, and payers frequently change their policies. In situations like the COVID-19 pandemic, the changes occur much more frequently, but changes also occur under normal circumstances.

Medical billing education covers the basics, but each specialty has its own codes and modifiers. Billers and coders who are new to emergency care billing need to learn the codes and be trained in the use of all expected modifiers.

As the population ages, more Medicare patients are coming into urgent care facilities. Therefore, it is important that billers are familiar with the various programs and the rules associated with them.