As the healthcare landscape continues to change, urgent care centers continue to see explosive growth. Driving their popularity is their ability to provide health care services quickly, affordably, and efficiently. In fact, most urgent care facilities have a wait time that’s 30 minutes or less and most visits take an hour or less. The urgent care market is so hot that private insurance claim lines for services offered in urgent care went up 1,725% between 2007 and 2016. Growth is expected to continue, with the market expected to hit $26 billion in 2023.
Although business is booming for the urgent care market, urgent care centers are in danger of losing a huge amount of money if they make billing and coding mistakes. Making billing and coding mistakes doesn’t just cost a few cents – it can make the difference between a successful or unsuccessful center. Here’s a closer look at 5 most common urgent care billing and coding mistakes, as well as information on how to fix them.
Mistake #1 – Failure to Fix Poor Front Desk Processes
Your revenue cycle starts at your front desk, and urgent care centers often make the mistake of failing to have good financial processes that begin at their front desks. It’s important to make sure you’re collecting co-pays at the beginning of patient visits instead of waiting until the end of their visit. Prior balances should be collected before you offer new services to patients. Failing to have good front desk processes in place can result in an increase in bad debt, lost revenue, and more patient accounts that end up in collections.
How can you fix this? Establish financial processes for your urgent care facility that start at the front desk. Make sure your front desk staff members are well trained in your processes. Have routine retraining for staff members to ensure everyone is up-to-date and following these processes.
Mistake #2 – Having Bad Contracts in Place
Setting up your contracts with payers involves entering a legal agreement with the payer in which they agree to reimburse your facility per your contracted fee schedule and market your facility as an in-network center in their network directory. Failing to set up contracts with payers means you won’t be able to accept insurance, making it tough to build patient volume.
Negotiating bad contracts can be nearly as bad as having no contracts, since contracts with low reimbursement rates mean you aren’t getting paid very much for the services you’re offering patients. The reimbursement rates you negotiate must be fair, reflecting the full scope of services provided by your urgent care center.
Insurance companies always want to lower their costs, so it can be an uphill battle to negotiation higher reimbursement rates. However, it is possible to renegotiate with payers to increase compensation rates. In many cases, hiring a contracting expert to take care of negotiations for you can be the best course or action, ensuring you get the best possible reimbursement rates to fuel your practice’s growth.
Mistake #3 – Failing to Follow Credentialing Guidelines
It’s important to understand that credentialing and contracting are not the same thing, and the processes are very different. Credentialing refers to the process used by a payer to verify the expertise, experience, and qualifications of a provider to ensure patient safety. Since every payer has unique credentialing requirements, don’t make the big mistake of assuming that each payer’s requirements are the same. It’s essential to ensure that providers are credentialed with payers for the urgent care center so claims can be processed correctly.
Some of the credentialing problems that many medical facilities run into when going through the credentialing process include lack of timing, poor organization, poor workflow, failing to keep contact information up to date, and failing to check into state compliance. The best way to deal with this mistake is to hire credentialing experts that can work with you to properly navigate the credentialing requirements of each individual payer.
Mistake #4 – Incorrect Documentation or Under-Coding Charts
Even with a great electronic medical records system in place for your urgent care, your EMR is only as good as the providers who use it. Failing to document items in the right sections can result in accidental under-coding, which results in a lot of missed revenue for the facility. Providers also need to make sure they are documenting exams, history, and MDMs correcting within the EMR system so office visit codes reflect what was done during the visit accurately.
Providers specialize in treating patients, not coding, so it’s important to work to make sure that urgent care providers are well educated on properly use of the facility’s EMR system. Refresher courses may be helpful from time to time as well.
Mistake #5 – Missing Valuable Charges
Missing out on valuable charges can cost your urgent care big time, and the cause of missed charges is often incomplete documentation. Patient visits can be so busy that it’s easy to forget to document a step, particularly if instructions have been verbally communicated. Some of the most commonly missed charges include x-rays, reading results, injections, blood draws, and labs.
Providers may also make the mistake of forgetting to document drug dosage amounts. The amount of dispensed drugs should be noted correctly so the right charges can be stated on claims to payers. Poor documentation for the visit will result in delays in claim submissions or claim denials.
Once again, it’s helpful to teach your urgent care providers to remember to document some of the most commonly missed charges. Using smart alerts in your HER system can offer reminders when providers are locking charts. Logging drugs dispensed and requested labs makes it easy to double check them against the claim charges in the future.
Mistake #6 – Making Mistakes Filling Out Claims
Making mistakes when filling out claims is another big urgent care billing and coding mistake you need to avoid. It can be complicated to fill out claims and including unnecessary information or forgetting important information on the claim can result in a denial. Forgetting to add in code modifiers or using the wrong modifiers can make your claim result in a denial. Other coding mistakes can include illegible handwriting on forms, forgetting to add an important modifier, or failing to make a diagnosis code as specific as it should be.
One of the best ways to avoid mistakes on claims that cost you money is to go with an expert billing and coding service provider that can navigate all the intricacies of submitting claims to prevent denials.
M-Scribe specializes in offering billing and coding services, as well as provider credentialing. Along with helping you avoid costly mistakes, M-Scribe can work with your urgent care center to prevent denials and ensure you’re getting as much money as possible from payers to keep your revenue cycle going strong.