Urgent care billing and coding is more challenging than other primary care medical billing and coding. Various payer reimbursement policies, frequent coding changes, and high deductible health plans increase difficulties for urgent care billing. According to the American Academy of Urgent Care Medicine, as many as 100 new urgent care clinics open every year but most of them struggle to have healthy revenue due to urgent care billing challenges. As urgent care billing was facing a lot of challenges prior pandemic, things got more complicated during the COVID-19 Pandemic. Urgent care delt with the lack of available personal protective equipment (PPE) and drastic fluctuations in inpatient visit volumes. Like most medical specialties, urgent care tried to adapt changed billing conditions to stay afloat. Of all challenges urgent care clinics faced in the last one and a half years, the following challenges affected them the most.
Urgent Care Billing Challenges
Introduction of Telemedicine
During the COVID-19 pandemic, urgent care providers were forced to adopt telemedicine services to reduce risk by remotely managing patient testing. Urgent care providers handled this changed patient care efficiently but they didn’t have sufficient time to prepare for new billing guidelines. It resulted in incorrect claims submission, more percentage of rejected claims, and rework on denied claims. As visit volumes increased, it created a unique challenge to spare time to work on training and reworking the existing billing process. Different payers have different telemedicine guidelines, understanding them and billing accordingly offered a unique set of challenges.
Not Following Revised E/M Guidelines
Evaluation and management guidelines are revised a lot during the years 2020 and 2021. New CPT codes were added for COVID-19 testing, vaccination administration, and telehealth visits. Most of the E/M guidelines were revised to support providers in this pandemic. If your team were not up-to-date on these E/M revisions then you might have left a lot of money on the table. Most urgent care providers billed without proper understanding of revised E/M guidelines which have resulted in claim denials and delayed reimbursement.
Uninsured Patient Program Portal
Health Resources & Services Administration (HRSA) established the COVID-19 Uninsured Patient Program Portal in April 2020. This program was offered to provide claims reimbursement to providers, generally at Medicare rates, for testing, treating, and vaccinating COVID-19 patients that are uninsured. For urgent care providers, reimbursement for claims submitted through the portal came with numerous difficulties. Clinics were reimbursed at Medicare rates but were often spending more money to see patients than was covered by the Medicare rate. Claims could only be submitted once, so clinics couldn’t submit claims for new charges associated with a prior claim. Securing correct identification and information for undocumented patients was difficult, and rejected or returned claims for these patients were hard to resolve as there was no appeal process for corrected claims.
Confusion Over COVID-19 Coverage
Urgent care clinics felt the effects of patient confusion throughout the pandemic. Patients were afraid and unsure of so much all at once: virus exposure, telehealth options, testing locations, test eligibility, and coverage of COVID-19 services. In addition to meeting the high demand of patients that needed tests, clinic staff had to answer more questions than ever as patients sought clarity and reassurance from their local providers. Patients came to urgent care clinics expecting free COVID-19 testing and care, but some received bills based on their insurance coverage which caused frustration and billing discrepancies.
One of the biggest challenges faced by physicians today is not patient care, instead, today’s primary care providers are concerned with the business side of health care, especially concerning medical billing and coding. Urgent care billing is no exception to that. Outsourcing your urgent care billing and coding could remove the billing burden and you can focus on patient care. Well-trained and experienced billing professionals can assure billing and coding compliance even during the COVID-19 pandemic. To know more about our urgent care billing and coding, contact us at info@medicalbillersandcoders.com/ 888-357-3226.
FAQs
1. Why is urgent care billing considered more challenging than other primary care billing?
Due to payer-specific reimbursement policies, frequent coding changes, and high-deductible health plans, urgent care billing faces unique challenges. Additionally, introducing telemedicine and revised E/M guidelines during the COVID-19 pandemic further complicated the process.
2. How did the COVID-19 pandemic impact urgent care billing?
The pandemic introduced several challenges, including adopting telemedicine without adequate preparation for billing guidelines, frequent updates to Evaluation and Management (E/M) codes, and issues with the HRSA COVID-19 Uninsured Patient Program Portal. These changes led to increased claim denials and billing errors.
3. What are the common issues with telemedicine billing in urgent care?
Telemedicine billing challenges include understanding payer-specific guidelines, incorrect claims submission, and the need for staff training on new telemedicine codes. These issues often led to claim denials and delayed reimbursements during the pandemic.
4. How did the HRSA COVID-19 Uninsured Patient Program affect urgent care billing?
The HRSA program reimbursed urgent care clinics for treating uninsured COVID-19 patients at Medicare rates. However, clinics often spent more than the reimbursed amount, and issues like lack of an appeal process for rejected claims and difficulty in collecting accurate patient information created further complications.
5. Can outsourcing urgent care billing improve revenue cycles?
Yes, outsourcing urgent care billing to experienced professionals ensures accurate claim submissions, reduces claim denials, and keeps the billing process compliant with updated guidelines. This allows providers to focus more on patient care and less on administrative tasks. For more details, contact info@medicalbillersandcoders.com or 888-357-3226.
