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Urgent care medical billing in simple terms

Urgent care billing is billing and coding for services to treat conditions that are not an emergency but need to be treated within 12 hours.

In terms of costs, this category of medical billing is usually more expensive than primary care, but cheaper than emergency care.

The billing and coding process for these services differs slightly from primary and emergency care, even though the nature of services is similar. These services have a specific set of Healthcare Common Procedure Coding System (HCPCS) codes, called the “S code”. These codes are useful in defining specific services that neither Medicare nor Medicaid recognize or reimburse.

What are the two types of S codes and how are they different from each other?

The two types of S codes are S9083 and S9088.

S9083 is commonly referred to as a “single, one-size-fits-all” code for reimbursement with a single flat-rate fee, irrespective of the costs or medical services. Although Managed Care Organizations (MCO) require healthcare providers to use the S9083 code, providers are likely to not get reimbursed for any complex care or additional costs.

S9088 is an “add-on” code that allows these centers to be reimbursed for a part of the increased cost of rendering service. The S9088 code must always be used with relevant Evaluation and Management (E/M) codes.

What are the most commonly used urgent care medical billing CPT codes?

Most of these CPT codes are part of Evaluation and Management (E/M) codes. Below are the most commonly used urgent care medical billing codes and their uses:

  • 99204 – These are for new patients and are the most commonly used billing codes. The rate of reimbursement is very high for these codes, while the risk of noncompliance is very low.
  • 99213 – These codes are for existing patients with lower levels of complexity. The rate of reimbursement is lower for these codes.
  • 99214 – The American Medical Association (AMA) directs that these codes be used where the number of problems addressed is not greater than two, and the level of complexity is moderate. Reimbursements for this code are usually quicker and higher than 99213.

Most common urgent care medical billing mistakes

Most of the common urgent care medical billing mistakes can be easily avoided if medical billers and coders diligently follow the credentialing and E/M guidelines. Below is the list of the most common mistakes so that billers and coders are aware of where they should have checks in place:

  • Bad contracts
  • Not adhering to credentialing guidelines
  • Locum frauds or mistakes
  • Not collecting all required information
  • Not adhering to E/M guidelines
  • Error in documentation
  • Error in filling out claims

Can outsourcing urgent care medical billing services solve these challenges?

According to Urgent Care Association, an industry trade group, the number of these centers in the US is growing at 7% per annum, with a staggering 11,150 centers having opened since the COVID-19 pandemic.

These centers are very busy every year during the flu season and the large number of patients waiting in line adds to pressure that in-house billers and coders have to deal with.

As more and more centers come up, healthcare providers will need to have dedicated staff to process medical bills on time with reasonable accuracy so that they get reimbursed for their services.

Therefore, a simple answer is that, if done properly, urgent care medical billing outsourcing is the best way to go about handling mundane yet critically essential administrative work like submitting claims and collecting reimbursement.

Outsourcing also unlocks a host of advantages and benefits that providers would not be exposed to if they were to hire an in-house team of medical billers and coders.

By partnering with a HIPAA-compliant and trusted medical billing and coding services company, providers can save on money spent in hiring additional staff, operational expenses arising from errors in billing or rework. All this and much more while paying a significantly lower price for services that would be offered by dedicated medical billers and coders with years of experience.

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