Urgent Care Billing Best Practices for 2024

In the ever-evolving healthcare industry, urgent care centers stand as crucial pillars, offering timely and affordable medical assistance to those in need. As the demand for these facilities continues to surge, ensuring efficient urgent care billing and coding practices becomes paramount.

In 2024, urgent care billing and coding guidelines are anticipated to undergo significant updates to enhance accuracy, compliance, and reimbursement processes.

According to studies, in 2023, urgent care clinics managed around 89 million patient visits, accounting for 29% of primary care visits and 15% of outpatient visits in the United States.

Over 70% of patients wait less than 20 minutes to see a practitioner, and 85% are treated within an hour, demonstrating the clinics’ efficiency.

To deal with these changes effectively, urgent care providers must adhere to best practices customized to optimize billing efficiency and financial stability. Let’s have a look at such practices to be implemented in 2024:

Urgent Care Billing Best Practices for 2024

• Code Selection Simplified

When billing for urgent care services, it’s crucial to choose the right code for each treatment or procedure. Make sure to understand the updated codes and choose the most appropriate one to avoid confusion and ensure you get paid properly.

• Accurate Documentation Matters

Make sure that you document everything accurately. This means detailing the severity of the patient’s condition, any additional services provided, and the level of care given. Also, be especially clear if standby services from a physician were needed.

• Stay Updated

Keep yourself updated on any changes in urgent care billing regulations. This could include updates to codes, payer policies, or documentation requirements. Staying informed helps you avoid mistakes and keeps your billing practices up to date.

• Understand Payer Policies

Every insurance company has its own rules for urgent care billing. Make sure you know the specific guidelines for each payer, including what they require in terms of documentation and how much they’ll reimburse for each service.

• Verify Patient Insurance

Before treating a patient, check their insurance coverage. This ensures they’re eligible for your services and helps you communicate any potential costs to them upfront.

• Make the Most of Technology

Use electronic health record (EHR) systems to your advantage. These systems can streamline your billing process by making it easier to document services and submit claims accurately and promptly. Additionally, leverage any available billing software or tools to help automate tasks and improve efficiency.

• Deal with Claims Quickly

Don’t let your claims sit around for long. Submit them promptly to avoid delays in getting paid. Keeping a close eye on your claim submission process ensures you’re not missing out on any revenue. You should also consider implementing processes or reminders to ensure claims are submitted in a timely manner.

• Handle Denials Wisely

If a claim gets denied, don’t panic. Develop a plan for appealing denials effectively. This means providing all the necessary documentation to support your services and addressing any issues that led to the denial. Additionally, it analyzes denial trends to identify areas for improvement and prevent future denials.

• Educate Your Team

Make sure your billing staff are well-trained and up to date on the latest billing practices. Regular training sessions and updates on changes in regulations can help prevent mistakes and keep your billing processes running smoothly. Encourage open communication within your team to promptly address any billing-related questions or concerns.

• Monitor Performance Metrics

Keep track of critical metrics like claim submission rates, denial rates, and reimbursement turnaround times. This helps you identify any areas for improvement and ensures your billing process is as efficient as possible. Regularly review performance metrics with your team and implement strategies to optimize billing efficiency and maximize revenue.

Outsource to 24/7 Medical Billing Services

You can also consider outsourcing your urgent care billing needs to a reputable medical billing service provider. These experts specialize in handling billing tasks, including claim submission, denial management, and reimbursement optimization. Outsourcing can free up your staff’s time, reduce billing errors, and improve revenue cycle management, especially for urgent care centers with limited in-house resources or expertise. Working with a dedicated billing service ensures consistent and reliable support for your urgent care billing needs, allowing you to focus on delivering high-quality patient care.