Mistake #16 — Using an ED or Primary Care Billing Company

Believe one who has proved it. Believe an expert.
— Virgil

In Mistake #15, we already covered the mistake of choosing a spouse or an inexperienced biller to do urgent care billing. So let’s assume you will not make that mistake, and you will look to outsource your billing to an expert biller.

Even so, you don’t want just any billing company, you want one that does excellent work and is expert at urgent care billing. We have helped many centers clean up the mess created by a competent billing company that did not really understand the unique aspects of urgent care billing. Choosing a billing company with specific expertise in urgent care coding and billing can be a key to the financial success of your new urgent care center. If you outsource, choosing the right company to do your billing, may be the most important decision that you make in starting your new urgent care center.

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  • Does the biller really understand the codes (and modifiers) that are critical to urgent care reimbursement? Urgent care coding is quite complex. It can take six months to a year for an experienced biller to learn the basics. Meanwhile your revenue cycle management will suffer delays, and even a 30-day delay in your cycle can mean you will have to borrow an additional $100,000 to keep your urgent care center open.
  • Will the biller really understand and chase difficult past due accounts? Some accounts (especially workers compensation cases) may take very long to collect.
  • Is the biller really an expert in urgent care services? There are only a handful of experts in billing and coding for urgent care centers.
  • How has the biller served other urgent care centers? Ask for several references. Make sure the references are urgent care centers that have been with the billing company for at least a year. Find out what their average days of accounts receivable (“average days in AR”)* have been. Find out what percentage of billings are written off as bad debt.
  • What rate will the biller charge? You don’t want the rate to be too high, and you don’t want the rate to be too low. You are not buying a commodity where price is the major determining factor. You need a combination of outstanding quality and reasonable fees. A biller will need substantial resources to do an excellent job billing for your urgent care center. Is the biller’s fee very low? If so, choosing the “cheapest” biller may be a very costly decision. A biller who collects 3% more than another biller, is always worth 1 or even 2 percent more than the cheapest biller.