Reimbursement Challenges in Urgent Care Billing

Urgent care is becoming the viable alternative to going to the emergency room. Patients are choosing this care because of the shorter wait times to deal with things like fever and minor accidents. Demand is soaring, and more people are choosing urgent care over waiting and going to their primary care doctors. 

However, the biggest issues facing urgent care are reimbursements and mistakes. Here are some of the most significant challenges in urgent care billing. 

Coding Regulations

Urgent care coding has many similarities to primary care. The challenge is the coder must know those codes that are most suitable for urgent care. This requires determining which codes should be applied to the bill. 

The situation is compounded by the fact that specific rules must be followed before submitting the claim to the insurance company or CMS. Failing to get the codes right increases the odds that the claim will be denied. This makes it more challenging for the healthcare provider to be fully reimbursed and bill promptly. 

Gables Medical Billing is the experts when it comes to medical billing. We are the number one physician's billing company in Miami and are current on all the latest regulations and coding procedures. We help you to avoid denials and streamline the process of getting your reimbursements. 

Timeframes to Confirm Co-Insurance

Another significant challenge facing urgent care providers is confirming the patient’s insurance coverage. Situations like this are troubling as you want to treat the patient and get them the services they need. 

The problem is that you don’t have time to make sure their insurance will cover the treatment. Later on, is when you can confirm everything and face the possibility of denials for the claim. The insurance company will state that they don’t cover this treatment, and it is the patient’s responsibility. You can try to bill the patient, but the likelihood of getting the money from them decreases dramatically. 

Gables Medical Billing can help you to confirm coverage. We handle all aspects of billing and back office support, so you can focus on the business of practicing medicine. Urgent care facilities face unique challenges, and we will help you to adjust with them and get everything right the first time. 

Medicare and Medicaid Challenges

Medicare and Medicaid are lowering their reimbursements for emergency services and urgent care. Both cover up to 80% of the costs, but it doesn’t include the costs of medical services. 

These programs see urgent care in a similar class as primary care and pay comparable amounts. The effects are, you could have your claims denied or receive lower payments from these programs. 

We are up-to-date on all of the billing practices for Medicare and Medicaid. Our team has the knowledge and experience, so you can avoid these challenges. 

Contact Us Today!

These are some of the challenges in urgent care billing. Contact us today and let us help you to streamline your billing and verification procedures. We are the best physician billing company in Miami and will get proven results for you. No one knows more about medical billing than we do.