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Urgent Care is often riddled with complications when billing out charges for various encounter types.
The ongoing changes in the healthcare environment have necessitated that a billing team have dedicated and prompt follow through on denials and no claim responses. The range of patient care issues provided by urgent care is wide and varied. Even though our focus is on medical billing and accounts receivable management, our broad experience across the entire Revenue Cycle Management process in Urgent Care is why we can give you an advantage compared to in-house billing.
Our team at Etransmedia has the knowledge and skills necessary to successfully work denials and provide our urgent care clients with valuable feedback to assist in managing and decreasing the most frequently seen denial types, while streamlining revenue and increasing your practice’s collection rates. Getting you paid fast!
What we know…
Urgent care centers are unique among other practice types. Between high patient volume and the variety of services an urgent care offers, urgent care centers are never short on challenges demanding their physicians’ attention. Unfortunately, this oftentimes means that urgent care centers lose a significant percentage of their revenue as well, due to inconsistent coding and poor AR management.
Urgent Care Centers were started as an affordable alternative to the emergency department for minor, episodic, unscheduled medical care. They can be located in or near the hospital that they are affiliated with. Unlike an Emergency Department that is open 24 hours, seven days a week, the centers have set hours that are open for more hours than a private physician’s office. Most facilities staff their Urgent Care Center with their ER staff and that is where the confusion can arise. The practitioner needs to keep in mind what setting the patient is being seen in. The same exam room on a Friday evening at 6pm is designated Urgent Care but at 11 pm it is now part of the Emergency Department.The E/M codes you will use for your 6 pm patient will be 99201-99215 with place of service 20 but your 11 pm patient will use 99281-99285 with place of service 23.
You should add modifier 54 (Surgical Care Only) to any surgical procedures with a 10 or 90 day global period if you are having the patient follow-up with their primary care physician or a specialist. The same rules apply for new vs. established patients in an urgent care setting. You may also not charge for two E/M services on the same day for the same patient. For example, a patient comes into the Urgent Care Center for a fever and a nasty cough. You determine that the patient has pneumonia and you admit the patient to the hospital. You can bill the visit to the Urgent Care Center or the hospital admission, not both.
On October 1, 2016 the Centers for Medicare and Medicaid Services (CMS) will no longer accept unspecified codes in most cases.
Starting in October, CMS requires greater specificity for claims filed in ICD-10-CM/PCS. The 12-month grace period originally introduced in 2015 said they would not deny claims for lack of ICD-10 specificity. That all changes on October 1, 2016. Payors will most likely follow suit if they haven't already.
First Pass Clean Claim Rate
Boost in Revenue*
Reduction in Cost*
We’re always on top of all the latest coding and billing updates for Urgent Care. Additionally, to make sure all claims are reimbursed on the first claim submission, our system is able to pre-edit claims prior to the initial submission for possible billing/coding errors. Our detailed end of month reports keep our clients up-to-date on what is happening in their practice so any issues can be addressed quickly. Having an experienced medical billing team, with visibility into performance, is vital to your practice’s financial health.
Although the new industry standards can be confusing and difficult to navigate, our dedicated team here at Etransmedia can assist in guiding you and helping to make your practice grow successfully.
*Please Note: Results are not guaranteed, implicitly or explicitly, and will vary based on several factors such as individual practice demographics, specialty, payer mix, operations, and management among others
Service and Technology Packages
Our customizable revenue cycle management service and technology solution packages allow you to outsource based on the specific needs of your practice
Silver RCM Service
This package has the core service and technology needed for revenue management allowing you maintain the responsibility of patient billing.
Gold RCM Service
This package includes the core RCM services with added denials, A/R management services, and full service patient billing
Ancillary RCM Services & Technology
Available to enhance any package