The process for getting proper reimbursement for urgent care services isn’t always simple.
A patient comes in to your urgent care center, is seen by a provider, the visit is charted, and a bill goes out to the insurance company. Seems like collecting that payment should be easy, right?
Even when centers have contracted case rates with a payor, often the reimbursement paid out doesn’t add up. Insurance companies bank on the different figure not being noticed by busy urgent care staff, or the unlikelihood that the urgent care operator will follow through with an appeal on the discrepancy.
Here are three tips to ensure your center is getting fair and accurate reimbursement for urgent care.
A big mistake urgent care centers make is setting fees for services right at the highest level set by payors. Since those rates could change every few weeks, the facility is not likely to keep up if the payor raises the figure. Codes also change frequently and typically the payor does not notify of the changes on specific codes or in general when a new overall fee schedule comes out. Then, when the center bills at the “old” highest rate, it’s actually leaving money on the table. Instead, the center should set fees 10 to 20 percent above the highest available fee to leave wiggle room for adjustments made by the payor.
Enter payor fee schedules into the practice management system.
Many payors won’t provide a full list of fees, but the center should request the schedule for at least 100 to 200 of the most commonly used codes and fees. It might not be easy to get this information, but you should push the payors you contract with to share it with the center. Having these fees readily available will remind the staff and offer guidance for coding appropriately to maximize reimbursement.
When a payor is not reimbursing the urgent care center at the correct rate, that information isn’t always caught. But a simple month end report, like those available at the click of a button in PV’s billing software, shows a breakdown of the financials and snapshots of outstanding accounts receivable. The report can be run to show trends by financial class, which could signal a problem (if there is one) in reimbursement levels.
Overall, the best advice for ensuring proper reimbursement for urgent care billing is to be diligent. Unfortunately payors sometimes rely on operators not having the time or willingness to follow through if a claim is paid out at the wrong amount. It’s not always easy, but it’s important to watch for bottom line success at your center.