How To Optimize Urgent Care Billing and Coding Services

How To Optimize Urgent Care Billing and Coding Services

Urgent care billing and coding services can be a complex affair. First, you must ensure that you have the right tools, which means following proper procedures and standards. If you want to optimize your urgent care billing and coding services, there are several steps that you must take. This blog will provide information about Medicare rules and guidelines, as well as tips on optimizing your urgent care billing services.

How Does the Urgent Care Billing Process Work?

Urgent care billing services are complex. Understanding how urgent care billing works is essential because it can be challenging to understand the critical differences between emergency and urgent care. Urgent care clinics serve a crucial role in our healthcare system by filling the gap between the primary care practitioner and the emergency department. That is likely why they are gaining popularity and are anticipated to be valued at $26 billion by 2023. However, to claim a fair portion of the market, you must first understand the fundamentals of billing and how to optimize your workflows for optimum return.

Overcome Challenges With Urgent Care Billing and Coding Services

  • Understand the difference between urgent care and emergency care.
  • Understand the billing and coding process for urgent care services.
  • Know what you’re doing with billing and coding matters before you start working with an agency or individual to help you get it done so that when it comes time to bill or code your patients’ visits, you’re ready!

Understand the critical differences between emergency and urgent care

Emergent care is provided in an emergency room, while urgent care centers are not. Urgent care centers can be opened by a physician or nurse practitioner with no formal medical training and may offer similar services to those provided at an emergency room (ER). For example, a patient with a minor injury or illness treated at an ER will often be seen by one of the physicians on staff there. In contrast, when you visit your local urgent care center, you’ll likely see someone who isn’t licensed as a physician—but still provides valuable medical advice based on their expertise and experience in treating common ailments like coughs and colds. The difference between these two types of facilities is significant because they serve different purposes: while both places provide essential healthcare services that help save lives each day through preventative measures like vaccinations against viruses like measles; however, only one type offers this kind of treatment 24/7, 365 days per year!

Stay up to date with Medicare rules

Medicare is a government program that provides health insurance to people aged 65 or older, underinsured, or having other qualifying conditions. The Medicare program pays doctors and hospitals for services provided to these individuals. Medicare has many rules and regulations that determine how it will pay for your services, so you need to know what changes have been made to your practice’s billing and coding practices to remain compliant with these new rules. If you don’t know about these changes ahead of time, it can cause problems when performing urgent care billing services for patients covered by Medicare. Here are some tips on how best to prepare yourself:

  • Identify any upcoming changes related to the Medicare program – When was this change announced? How does this impact me as a provider? What do I need from my patients now for them to receive proper reimbursement after the implementation date?
  • Understand how these changes affect your practice – Will all urgent care providers see increased costs due directly back at them because we’ve failed at adequately following up with our patients’ paperwork after their visit ends up being denied altogether due solely because one item wasn’t filled out correctly? Or maybe it’ll just mean higher prices across the board within certain categories until we get things figured out later down the road once more updates arrive, which could potentially include even more delays than originally planned.

Promptly Handle denied or rejected claims

It is essential to distinguish between a rejected claim and a denied claim. A rejected claim has not yet been processed because one or more errors were discovered. It prevents the insurance company from paying the payment in full. On the other hand, a denied claim is one that the insurance company has reviewed and determined to be unpayable due to a discovered violation of the payer-patient agreement or some critical error revealed after processing. In both circumstances, the payer will return the claim to the biller and explain the issue. A rejected claim can be adjusted and resubmitted, but a denied claim must be appealed before it can be resubmitted, which is a considerably more expensive and time-consuming procedure.
Checking for problems in a claim helps reduce the possibility of rejection and denials, but if they arise, handle them as soon as feasible. Maintain contact with a payer representative; they can help understand issues with the original claim and provide details on current claims as they are handled. These can help speed up the claim editing procedure and reduce the time required for appeals and resubmissions.

Follow ICD-10 standards for an efficient coding process

ICD-10 coding is mandatory for all providers. Coding with ICD-10 is more detailed than coding with ICD-9 so you can expect a higher volume of cases. In addition to the number of codes and categories, there are many other differences between these two systems that make them different.
The most notable difference between these systems is the specificity level: ICD-10 has a higher specificity than ICD-9. This means that when you input your code into an EHR system, you will receive more accurate billing information based on how seriously your provider treated your patient’s condition during their urgent care visit (and vice versa).

Tracking Denials

Errors in patient data, inadequate documentation, and other information issues can result in dismissed claims. Monitoring these refused claims allows you to identify flaws in your urgent billing practice. This will enable you to change your billing approach to one with a lower margin of error.
Identifying where your problems are will help you solve them. As a result, you can correct your errors and significantly increase claim approval rates. Remember that it is critical to track regularly, as patterns of negative behaviors appear only then. It is also good to teach your employees. Employees can make mistakes because different insurance providers have different regulations that must be handled differently. Thus, teaching your team to be more aware of various procedures and less likely to make errors in the payment process for any organization is one technique to correct faults.

Ensure that your EHR supports urgent care services

Before you go into the coding and billing process, ensuring that your EHR supports urgent care services is essential. Here are some of the basics:

  • ICD-10 codes for urgent care
  • Specialty modifiers for urgent care
  • Specialty charges for urgent care

If your EHR supports these features, then you should be able to complete an effective billing process for all types of urgent care.

Use patient statements effectively

Patients are important to your business. They are the ones who come to you for care and make appointments, so you must take care of them. When patients make an appointment, they give away personal information about themselves—like their name, address, and phone number—which is stored in the patient’s medical record. The information in their medical records helps others (like doctors) treat them when they need help.
Patient statements can be used effectively by urgent care physicians to track progress on treatment plans with patients and improve patients’ experience at urgent care facilities like yours!

Outsourcing your urgent care billing and coding services

Outsourcing your urgent care billing and coding services can help you overcome challenges in the billing process. Benefits of outsourcing include the following:

  • Access to an experienced team of specialists who specialize in coding, providing a more efficient means for improving patient outcomes and reducing costs.
  • Skilled staff trained to handle complex issues like chronic illness management can sometimes be difficult for physicians to manage independently.
  • Outsourcing the urgent care revenue cycle management services allows practices to focus on patient care and get reimbursed faster.

The challenges of outsourcing include the following:
First, find the right partner (who has experience working with payers) that will provide access to quality services at a reasonable price without sacrificing quality control or customer service standards.


Urgent care billing and coding services are a complex affair and may require you to hire an expert. While you can do the coding and billing yourself, it’s better to outsource this task to someone with the experience and expertise. Outsourcing can help you increase your revenue by providing accurate billing for urgent care services. Our team at CureCloudMd understands the industry, so we can help you manage your urgent care billing services effectively. Contact us today for more information about how we can help!