Understanding the Major Variants in Urgent Care Billing

urgent care billing

Urgent Care Centers are very clearly defined in the US healthcare scenario. According to the Centers for Medicare and Medicaid Services (CMS), an Urgent Care Facility is categorized as “Place of Service – 20” (POS-20) and is defined as a place for receiving immediate medical attention by unscheduled, ambulatory patients. This ‘place’ should be a location which is distinct from a physician’s office, a hospital Emergency Room or a clinic.

Most Urgent Care Centers (82%) register themselves as POS-20 and contract with insurance payors as such. While this limits their scope of services than say, a Primary Care Provider (PCP), it has certain pecuniary benefits. The main advantage is enjoying a higher rate of reimbursement which ranges from $130 to $160, depending which state the center is located in.

It is interesting to note that a certain percentage of Urgent Care Centers (20%) choose to bill under the POS-11 category which belongs to Primary Care Providers. Not only does it entail a lower rate of reimbursement (hovering at around $90), it also robs Urgent Care facilities of their distinctive identity. However, such a decision becomes inevitable when the market is saturated or an insurance provider will not accept any more POS-20 contracts.

Whatever be the variant that an Urgent Care chooses to bill as, it is of crucial importance that the claims are clean and get accepted by the payor. Urgent Care billing is often plagued by issues that are common in other kinds of medical billing. Wrong codes, missing or erroneous patient information, delayed submission, failure to adhere to the payor’s protocol – all of these can lead to claims getting rejected or denied.

This is why many Urgent Care centers choose to appoint dedicated billers and coders, often on an offshore, outsourced model. More often than not, there is a reduction in operational costs and an improvement in the collection rate. So Urgent Care centers are well-advised to pick a professional and reputed billing company as a partner without delay if it starts to notice a drop in the collection rate.