Common Mistakes to Avoid in Urgent Care Billing

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Urgent care is, as the name suggests about services which are required for an illness or injury that would not result in further disability or death if not treated immediately, but does need professional attention as it has the potential to develop such a threat if the treatment is delayed longer than 24 hours. Many new urgent care services are cropping up by the day across the nation. It is necessary to follow a proper billing and coding process so that all claims are reimbursed and no claim gets lost. However billing mistakes commonly do happen in urgent care billing services and claims can get rejected for various reasons. The reasons include,

Using wrong diagnostic codes

Rejection due to non-specificity of codes

On validation about medical necessity of service

Indirect linking of codes

Replacing physician services with physician assistants (PAs) or nurse practitioners (NPs)

Using a not experienced coder

Hiring a not certified professional coder

Billing confusion over “incident to” services

Inefficient collection at the front desk staff

Urgent care center doing laboratory tests without a CLIA (Clinical Laboratory Improvement Amendments) waiver.

Using durable medical equipment (DME) without a separate billing number

Using staff not aware of changes in healthcare reimbursement that affects payments

Coder not trained specifically for urgent care

Wrong person signing for “minor” patient claims

Not verifying at the outset the guarantor’s insurance card and identification

Using CPT codes 99281-99285 meant only for hospitals

Not being able to distinguish between new and established patients

It is true that there is often a shortage of urgent care specialized coders but one must remember that wrong coding can delay payments or even lead to litigation.

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