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Urgent care is a lucrative business affair. Being a crucial domain in the healthcare landscape by providing immediate medical attention for a wide range of conditions, running its billing seamlessly is quite an affair. The process of billing for these services is unique and requires a nuanced understanding of coding and billing guidelines.  

All about urgent care billing guidelines: 

  • Understanding S Codes – Urgent care providers evaluate and treat conditions similar to those in a primary care setting. However, there are specific HCPCS codes, denoted with an “S,” designed for urgent care billing. Originally designated by BCBS, many other payors now accept these codes. They are exclusive to urgent care facilities and are often required by payors for reimbursement. 

  • Regulatory Requirements – Before sending a bill to a patient or payer, it must adhere to regulatory requirements, including HIPAA and the Office of the Inspector General. Ensuring billable charges and compliance with payer rules is vital to avoid denied claims and complications in the billing process. 
  • Claims requirements – all urgent care claims needs to be submitted before or on time. Any delay will only result in denied claims and a lot of rework and late reimbursements. 

Coding Guidelines for Urgent Care Billing: 

  • Translating Diagnoses and Procedures – After a patient encounter, a coder translates diagnoses and procedures into universally accepted medical codes such as ICD – 10 for diagnoses and CPT for procedures. CPT codes are divided into three categories, with Category 1 codes being the most common in urgent care billing. 

With so much to understand and remember, today urgent care providers also need expertise to cater to the rising urgent care patient’s volume and this is why many are choosing the option of outsourcing. 

Sunknowledge – a complete urgent care outsourcing solution across the USA : 

Streamline billing processes, eliminating redundancies, and enhancing collections, Sunknowledge Services Inc., allow you to focus on delivering patient centered care while the expert handles the intricacies of billing. With a solid understanding of the specific codes and guidelines, the experts not only navigate the complexities of billing but further shrink your operational expenses by 80 %. Saving both of your time and money, Sunknowledge the one stop RCM destination has got you all covered by maintaining compliance with regulatory requirements or be it ensuring a smooth revenue cycle and the financial health of the facility. 


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