As the name suggests, urgent care is a quick solution to emergency medical conditions. The basic meaning indicates that urgent care centers are like hospital emergency rooms. But the core identity of both is different. Emergency rooms or departments are helpful in life-threatening conditions, and they are equipped to handle traumatic injuries like fractures, excessive bleeding, head injuries, seizures, etc.
On the contrary, urgent care centers are responsible for the treatment of unforeseen illnesses that are acute but not fatal. Usually, disorders or injuries that are minor but cannot wait until the next day for treatment are managed in urgent care centers. The convenience of such centers gives a middle ground to patients. As a result, the medical industry is witnessing a rise in patient size seeking affordable, quick and efficient urgent care facilities.
These centers are flourishing in terms of business and providing quality care at the same time. Even though the situation seems attractive, it comes with its consequences. As a matter of fact, positive cash flow is what determines the success of any business. For urgent care providers, claim reimbursement is a way to be a successful business. Any errors in billing and coding can result in a loss of well-deserved revenue.
Since the focus of care providers is mostly on the patients, the possibility of making mistakes in the billing process is natural. On top of that, managing two things at the same time can be tiring and take up a lot of time. This cumbersome process may result in unwanted billing and coding errors.
Let's Look at Some of the Basic Mistakes that Affect the Revenue Cycle of an Urgent Care Center
Omission in Front Desk Process
The process of receiving revenue begins at the front desk when a patient visits an urgent care center. At this very moment, all the information is collected to ensure the range of insurance coverage. It is the responsibility of the front desk officials to ensure the collection of co-pays if in case any prior to offering new services to the patients. This is vital to reduce the non-payment of full payment after the services are already rendered. Omissions and mistakes at the front desk result in loss of revenue due to bad debts and slow down the claim submission process.
Insurance verification is a must to forecast potential billing problems and take corrective actions to streamline the workflow and reimbursements.
Either Bad Contracts or No contracts at all
It is a good idea to sign contracts with the payers and enter into a legal agreement before offering any services. These contracts list the fee structures for the reimbursements that the payer has agreed with. It also markets an urgent care center as an in-network facility. Entering a contract is a direct indicator that you are accepting the insurance to give patient care. A failure in setting up a contract reduces the number of patients as it depicts an inability to accept insurance.
Either bad contracts or no contracts result in reduced reimbursements against the high cost of services offered. Urgent care centers need a fair negotiation for the quality of services that are offered to receive higher reimbursements.
Neglecting Credentialing Guidelines
Credentialing is a useful tool for payers to know the essential details of the facility they are paying for. It is a process that verifies the expertise, experience and qualifications of the service provider. Being aware of these details ensures patient safety and helps in building trust with the care provider. Different payers have different credentialing requirements. It is the duty of the care providers to analyze the requirements of each payer separately to ensure correct claim filling.
You must avoid credentialing mistakes like poor time management, failure to keep contact information up to date, faulty organization, inefficient workflow, and failure in following required compliance measures.
Documentation Errors or Under-Coding
No doubt EMR (Electronic Medical Records) is an efficient system for the documentation process. But it's of no use if the one who is documenting all the information on this technological platform is making mistakes. There are also high chances of accidental errors which can result in under-coding. A little negligence will lead to missed revenue. Care providers need to make sure that documentation is done with precision where the codes are filled accurately.
This issue can be solved with proper training of care providers in using EMR systems to ensure accuracy.
Errors in Specialty Specific Codes
E/M coding involves specific CPT codes to facilitate billing for urgent care centers. Over the years, E/M coding has been going through renovations and regulatory updates. The staff needs to prioritize the changing codes to ensure accuracy in coding and billing. This will save the care facility from denied claims and prevent the staff from rectification and rework of filing again.
Coding can bring all the fortune for the urgent care center but if not done correctly then it can cause revenue losses and inefficient workflow. With regular training, the probability of errors can be reduced. The focus must also be on preventing mistakes like forgetting vital modifiers or failure in making specific diagnosis codes.
Overlooking Valuable Charges
When it comes to charges, overlooking is the reason that can induce loss to the care center. Generally, charges get missed due to incomplete documentation of the information. Urgent care centers are popular among people, making them a busy place to be. Handling numerous patients at the same time can increase the burden on the staff, making the documentation process prone to omissions and errors in the steps. Every step is valuable as they are charged individually, mistakes will only result in submission delays and claim denials.
The staff can remember some of the most common missed charges so that the chances of future mistakes can be reduced. Double-checking is another way to deal with such situations.
Urgent care providers put immense efforts into providing quality care to patients and together with that they also handle the hassle of billing & coding. All these efforts are enough to justify the need for high reimbursements. However, the above-mentioned mistakes are a roadblock for the care providers. Even with a few changes and efforts, an urgent care center can eliminate these mistakes but there are better options out there like an outsourcing partner.
Unify Healthcare Services is a top medical billing company proficient in bringing improvements to your urgent care facility. We provide customer-specific services to transform healthcare and enhance the efficiency of care providers. With Unify, you can reduce overall operational costs and boost your revenue cycle. We use advanced technologies and create strategic solutions for healthcare facilities and professionals to simplify their practice. Partner with us to reduce the complexities and minimize medical billing denials while reducing administrative costs.