Urgent Care Billing; A Guide for Newly Established Practices

Urgent Care Billing

Your practice has a decent patient volume and good online reviews, and you’ve hired a few compassionate providers. However, you’re not seeing the profit margins you’d like. One possible reason is that your billing processes aren’t up to par. You can increase your revenue and maintain a good reputation with some tweaking. Additionally, due to unpredictable fluctuations in patient flow coupled with the fast-paced environment, Urgent Care Billing is more complex than other Medical Billing scenarios. Here are some tips for improving your billing.

Urgent Care Billing - NEO MD
Urgent Care Billing – NEO MD

What does Urgent Care Billing mean?

When it comes to paying for urgent care, billing is critical. Often, missed charges result from incomplete documentation. This means that a patient may not have had a complete exam and may have forgotten to have their x-rays or labs drawn. Missed charges may also include incorrect medication dosage amounts in the medical record. Ensure your urgent care billing service has the experience to avoid this problem.

Many mistakes can cost you thousands of dollars. It’s also important to make sure your billing process is error-free. Incorrect billing can prevent you from collecting your total revenues. Incorrect billing can prevent your center from receiving insurance payments. Make sure your billing practices are compliant with the rules of health insurance companies and ensure you meet your financial obligations. Otherwise, you might end up facing legal issues. As a result, billing for urgent care must be done correctly to avoid unnecessary expenses.

Urgent Care Billing; Precise Overview

Urgent care medical billing is complicated and often follows a similar procedure to primary care. However, the billing process is more complex and requires strict billing and coding guidelines. There are several risks and hiccups that can hinder revenue cycle management. Outsourcing your billing can streamline the process, reduce redundancies, and increase collections. Outsourcing also frees up staff to focus on patient care.

Aside from the complexity of the process, billing for urgent care has some straightforward rules that will make life much easier for you and your patients. The first step in urgent care billing is to define what services you offer and determine which insurances you accept. If you accept most insurances, it’s best to understand the policies and procedures for determining which payers will get your services.

In general, you’ll bill for the level of service that you’ve provided to the member. If you provide an emergency service, you’ll likely bill for the physician’s level of care, regardless of the actual type of service you provided. If you offer additional services during the visit, you must report the appropriate E&M codes. You’ll need to document your time and complexity when billing for these services.

How Does Urgent Care Billing Process Work?

Despite its complexity, the urgent care billing process is often similar to primary care in many ways. It should follow coding and billing guidelines and comply with regulatory requirements. A minor hiccup in the billing process can significantly impact revenue cycle management. Consider outsourcing your billing tasks to a third-party company to streamline the process. Outsourcing can reduce redundancies and improve collections. Read on to learn more about the benefits of outsourcing your urgent care medical billing needs.

Urgent care billing and Coding require specialized knowledge and expertise. Urgent care services can bill on a level-of-service or flat-rate basis. CPC-certified coders assign accurate S codes and know private and managed care insurance, CPT procedures, and USA reimbursement regulations. Our billing services for Urgent care can offer 24/7 workflow, detailed billing reports, and responsive client support.

Ideally, urgent care centers should have a contract with their insurers. Failure to do so will result in considerable bad debt and less revenue. Even if you have a low reimbursement rate, a contracting expert can help you negotiate higher reimbursement rates. This way, you’ll avoid a potentially costly mistake: having no contract. By hiring a professional urgent care billing company, you’ll have access to expert guidance that can help you get higher reimbursement rates.

 Urgent Care Billing
Urgent Care Billing

Urgent Care Billing and Coding Guidelines

If you are a physician, you may be concerned about the new CPT codes. Urgent care clinics have a long history of documenting visits a certain way. As a result, they developed habits around the old way of coding. By ignoring the new guidelines, you will risk an audit. That means leaving money on the table. Here are some tips to make your practice compliant with the latest codes.

In order to bill for urgent care, you must use the correct CPT codes. These codes begin with S and are specific to urgent care. The codes S9082, for example, fall under emergency care and are paid for by private insurance providers. Medicare does not accept them as primary care visits. While common, not all private insurers automatically reimburse urgent care services. Therefore, it’s essential to check the requirements of your specific insurer before billing.

Know Your Revenue Gaps

If your practice is still a new business, you may have a small list of potential revenue gaps. Use these as a guideline to determine what needs to be coded. If you don’t have a complete list of these guidelines, consider a consulting firm to help you with this process. Some companies offer free or low-cost services to help you maximize your revenue.

Understand the Codes for AMA Payments. These guidelines can help you understand the requirements for reporting and billing urgent care services. In most cases, you must invoice POS 20 and Office Visit E/M codes. Be sure to document all services performed on the same day. While this is a standard AMA reimbursement criterion for urgent care services, you’ll need to check with your provider for any specific requirements.

Commonly Utilized Urgent Care CPT Codes

Generally, urgent care facilities bill only Category I codes. This includes 99213 and 99214, which are not as complex as those used for the emergency room. However, these two CPT codes are not as common and do not typically reimburse as much as the other categories. Among these, 99204 is the most common code used for a new patient, a service that requires a complete medical history and exam and moderate complex medical decision-making. Consequently, this code has a relatively high reimbursement and low risk of noncompliance.

While Urgent Care CPT codes are used for emergency-related visits, they can also be used for routine visits to the doctor’s office. The main difference between the two is that the first code is used for a walk-in patient, while the second is used for a scheduled appointment. In a walk-in patient, CPT S9088 can be billed. However, this code is not valid for Medicare or Medicaid insurance.

Because the AMA controls CPT codes, it is not free to use them. In addition, explanations of CPT codes are not accessible and cannot be downloaded online. In addition, you need to register to use the CPT code search tool, which is only available for registered users. Despite the cost, you can easily find a list of the CPT codes used by urgent care facilities and use them to bill for your services.

Front Office and Urgent Care Billing

While many urgent cares are able to sustain decent patient volumes with the help of dedicated staff and online reviews, they often fall short of profit margin expectations. This is often the result of poor billing processes, but there are several ways to improve your revenue. Consider outsourcing your urgent care billing and front office operations to a professional organization. The benefits of outsourcing your billing operations are plentiful.

To begin with, the front office team will be responsible for scheduling appointments with the correct doctors. This requires excellent time management skills. Most patients do not appreciate being kept waiting while their doctors consult with them. In addition, the front office staff will need to follow up with patients and maintain updated financial records. Ultimately, they will be the face of your clinic. This will help your clinic build a good reputation.


Our specialized crew of medical coders and billers can help you grow your practice. Our staff complies with all Medicare Urgent Care Billing and Coding requirements to ensure maximum reimbursement. The danger of claim denial and refusal is decreased through real-time, rapid, precise, error-free coding of each claim and an early inspection to confirm claim eligibility. Leading US revenue cycle management companies are in charge of many newly – built healthcare facilities. Most healthcare organizations likely accept the services of just a few medical billing companies.

NEO MD Medical Billing has been working with different urgent care centers across the US. With more than 15 of experience in emergency rooms and urgent care billing, we have created novel solutions that have revolutionized the revenue cycle management industry.

Comparing NEO MD’s urgent care billing services against those of other revenue cycle management firms, they are regularly regarded as the best in the US. For small, medium-sized, and big clinics, NEO MD also offers medical billing services. Additionally, we offer customized billing services to practitioners throughout all US states. So, for acquiring services, the healthcare facilities find NEO MD the best Medical Billing company near me.

What Makes NEO MD the Best Urgent Care Services Company?

NEO MD stood best among competitors in terms of providing good Revenue Cycle Management services to practices due to the following cores;

  • Our experts work hard to reduce your front-end denials by 20%.
  • Offer Provider & Staff Productivity Analysis
  • Identify potential under, over, and incorrect coding scenarios
  • Provide fortnightly financial and practice overviews 
  • Offer internal Medical Billing audits to uncover loopholes
  • Out of Network Negotiations.
  • Use the latest technology and tools to ensure the accuracy of claims and faster collection.
  • Refunds adjustment and Payment posting to improve the cash flow.
  • Improve RCM system efficiency with a robust credentialing team. 
  • Offer Services that are easily scalable at all times 
  • We have consistently increased the collection rate (Urgent Care Billing) for our clients

Let’s schedule an appointment and discuss it in-depth with Medical Billing and Coding specialists. Contact us now at ([email protected]) or (929) 502-3636).

Urgent Care Billing
Urgent Care Billing

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