Millions of patients visit urgent care centers each year to get quick and reliable healthcare. However, billing for these services is tricky and can result in delayed payments or revenue loss. According to recent research, urgent care clinics managed about 89 million patient visits in the U.S. in 2023. This makes up 29% of primary care visits and nearly 15% of outpatient visits. These clinics are popular for their quick and convenient care. Over 70 percent of patients have less than 20 minutes before they actually get to see a provider. And, of course, more than 85 percent finish up the visit within an hour. 

This guide will walk you through the basics of medical care for urgent billing and offer practical advice to keep things running smoothly.

What is Urgent Care in Medical Billing?

Urgent care billing covers services for non-emergency conditions that still need timely attention. These include things like fevers, colds, flu symptoms, ear infections, seasonal allergies, and insect bites. It also applies to minor injuries like sprains, small fractures, and cuts that may need stitches, vomiting, diarrhea, mild asthma, abdominal pain, back pain, and even X-rays or lab tests.

Now you would have a basic idea of what urgent care is. Let's dive in on how it works.

How Does Urgent Care Billing Work?

The urgent care billing process is important as it helps care centers manage their revenue. This process starts at the front desk, where staff collect important details like the insurance and personal information of the patient. It is one of the most important steps for accurate billing to receive payments as early as possible.

After the patient has visited the provider, the medical team records the treatments and procedures in the electronic health record (EHR). This record is used to prepare a detailed bill for the patient’s insurance. Next, the bill is sent electronically to the insurance company. The bill contains details about the diagnosis of the patient, procedures performed, and their charges. In the details, accuracy is important to avoid delay or failure of claims.

These emergency care centers can save time, reduce stress, and get paid faster by keeping the billing process simple and reducing mistakes.

Understanding Categories of Urgent Care CPT Codes

They rely heavily on CPT codes to describe the services provided.

• Category 1 CPT codes are the most commonly used and include a wide range of healthcare services. 

• Category 2 CPT codes are optional and focus on tracking performance to improve care quality. 

• Category 3 CPT codes, which relate to new or experimental technologies, are rarely used in emergency care centers.

Common CPT Codes

As we discussed the categories of CPT codes, let's discuss codes that come from category 1.

• 99214

This code is used for existing patients who need a detailed exam, moderate medical decision-making, and a complete patient history. It’s commonly used for more complex visits.

• 99213

Code 99213 applies to patients who need low-complexity treatment. While it has simpler requirements and lower reimbursement compared to 99214, it is widely used due to its simple criteria.

• 99204

This code is for new patients and requires a full medical history, a comprehensive exam, and moderate medical decision-making. Although it offers higher reimbursement, it can be more challenging to meet compliance standards.

Importance of Urgent Care Billing for Healthcare Providers

Urgent care centers rely on proper billing practices to stay financially stable and keep growing. Accurate billing helps centers get paid for the services they provide, which enables them to continue delivering quality care to patients.

Supporting Revenue Cycle Management

Billing is one of the significant components of revenue cycle management. It deals with everything from patient registration to getting full payment. With the effective use of billing systems, urgent care centers can have steady cash flow, meet their financial needs, and plan for future growth. A robust Revenue Cycle Management (RCM) process helps centers invest in new technology, expand services, and hire more staff, all of which contribute to better patient care.

Decreased Claim Denials

Another goal is to reduce claim denials. A center's finances, administrative costs, and patients' frustrations are all adversely affected when claims are denied. Urgent care centers can minimize the risk of claim rejections by using correct coding, thorough documentation, and proper insurance verification. It increases revenue and improves the patient experience by avoiding unexpected bills, building trust, and creating a more positive relationship with patients.

Compliance with Rules and Regulations

It is strictly regulated under HIPAA and Medicare/Medicaid guidelines to ensure patients' privacy and correct billing. Centers that adhere to these regulations can avoid penalties, legal issues, and bad publicity. By meeting these standards, providers can maintain their reputation while ensuring they comply with the law.

What Are the Differences Between Urgent Care and Emergency Room Billing?

The processes of billing for urgent care and emergency rooms may sound the same, but there is a critical difference that any provider needs to know. In fact, CMS requires facilities to formulate their own guidelines for billing, depending on the type and intensity of care provided, but most people think that the processes of billing are the same for urgent care and emergency rooms, which is far from the case. 

Emergency room billing is more complex because of the high charges and documentation, which is a critical nature of care. On the other hand, urgent care billing is less complex but still needs to be coded accurately and within compliance to avoid claim denial.

Many people think that the two billing systems are the same, but they’re not. That’s why having experienced and certified billing professionals is essential. They can navigate the guidelines for each and help reduce errors that delay payments.

Challenges 

• Fixing Coding Errors Quickly

Coding mistakes are one of the common errors found in healthcare care billing. Such mistakes can cause loss of revenue and delay. In case the diagnoses and treatments are written wrong, claims may get denied or less paid than what was anticipated. Since urgent care centers work fast, the chance of mistakes is higher. To overcome this, make use of an electronic health record (EHR) system.

• Decrease Claim Denials

Claim denial will also slow down the process of billing, which often results from incorrect patient information, missing information, or coding errors. To counter this issue, use EHR software that provides error checking in real time.

• Maintaining Regulations

Following rules like HIPAA is important. Not staying compliant can result in penalties and damage to the practice's reputation. EHR systems make compliance easier by automatically checking and updating to meet current regulations.

• Improving Billing Efficiency

Traditional billing in urgent care can be slow and inefficient. Manual data entry and separate systems often cause delays and extra costs. By using an EHR system, many of these tasks can be automated.

• Streamlining Insurance Verification

Insurance verification is one of the hassles associated with urgent care. In a manual process, it causes delays and mistakes. EHR systems streamline the whole process by checking eligibility in real-time.

• Getting Paid Quicker

For urgent care centers to remain financially sound, they must be paid. Unpaid or delayed accounts can cause cash flow disruptions. EHR systems make it easier for payment collection through online payment options via patient portals. In this regard, the EHR makes the payment process more efficient and hassle-free.

Comparing Cost: In-House vs Outsourcing

When managing urgent care billing, you have two main choices. First is to handle it in-house, and second is to outsource it to experts. Both options require software and other costs. While some prefer full control, in-house billing can be more expensive. You’ll need to pay salaries and benefits and cover the costs of employee absences or turnover, which can disrupt your billing process.

Whether you choose in-house or outsourcing, we’re here to help. Contact us today to find the most efficient and cost-effective billing solution for your urgent care center. Let us handle the details so you can focus on providing quality care.

Conclusion

Understanding urgent care billing is essential for keeping these facilities financially stable. Staying updated on the latest guidelines and by using efficient billing practices and getting help from experts will make a whole difference. These steps ensure accurate payments, smoother workflows, and more time to focus on patient care. With the right approach, urgent care centers can simplify billing and keep their operations running effectively.

Don’t let billing errors slow you down. Partner with us for accurate, efficient, and timely billing services. Contact us today to schedule your free consultation to see how we can help improve your billing process!

FAQs

How Does A Billing Error Affect A Business?

This may lead to delayed payment, the rejection of a claim, or even an audit, which can have an impact on cash flow and working operations.

How Often Do the Billing Guidelines Change?

These coding guidelines are updated regularly, based on the advancement in healthcare practices and technologies.

Can We Bill For Telehealth Visits Now?

Yes. We can bill for telehealth services under the new codes just as we do for in-office visits.

Why Is Urgent Care Billing So Complicated?

It can seem confusing because different services, codes, and guidelines must be followed. But the purpose of these updates is to make billing clear and reduce mistakes, so you’re not overcharged or facing claim denials.