Mistake #14: Ignoring urgent care billing
A common theme in struggling and failing startup urgent care centers is a disregard of urgent care billing and revenue cycle management. In order to be successful in urgent care, you must have access to outstanding experts in the seven C’s of urgent care billing:
- Contract negotiations
- Credentialing
- Coding
- Compliance
- Claim submission
- Claim formatting
- Collections
You are the proud owner of a new business-an urgent care center. If you owned a McDonalds or a Laser Quest franchise, you would have to master the ins-and-outs of pricing, expenses, and credit card billing. The business side of urgent care is coding, billing and collections.
So how do you learn all of the ins and outs of urgent care billing? The answer is simple; you can’t. You have to focus on business plan, pro forma, floor plan, building codes, signage, marketing, lines of service, patient complaints and a hundred other business items.
BUT you will never succeed, if you fail in the critical aspects of urgent care billing. So how should you handle billing in your urgent care?
Hire an urgent care biller: If you can find and hire an experienced expert urgent care biller, this may be a good option. From our experience, finding this expert is difficult and risky for the following reasons:
- Scarcity: There are very few experts in urgent care billing, so finding an employee with true expertise in every area of urgent care billing listed above is next to impossible for a startup urgent care center. Even established, multi-site urgent care centers struggle to find these experts.
- Cost: In addition, if you do find a true expert urgent care biller, that person will likely demand a salary outside the range of the typical urgent care startup budget.
- Risk: Another problem with hiring your own biller is that it fails the hit-by-a-bus test. Of course, no one wishes for a staffer to have an accident, but the truth is that many urgent care startups that hire their own biller end up losing that biller, due to illness, injury, termination or resignation. What happens then is ugly. The center usually gets months behind in revenue cycle management. In recent years, we are aware of several otherwise-successful urgent care centers that have failed or almost failed due to losing this critical link in the financial chain of an urgent care center.
So what is your other option?
Outsource to an Expert Urgent Care Biller: Now, you may suspect that answer is self-serving; after all, our sister company PV Billing uses Practice Velocity software exclusively and is the largest urgent care biller in the USA. Even knowing that, maybe you should consider the following reasons to consider outsourcing your urgent care billing?
- Simplicity: You need to focus on all of the thousands of details that can not be outsourced. Finding an urgent care billing company will allow you to focus on attracting and treating patients with excellence.
- Cost: By outsourcing your billing, you can access experts with great experience in urgent care billing at a fraction of the cost of a full-time employee.
- Expertise: Rarely can an urgent care center find a single urgent care billing specialist (let alone the over 85 billers at PV Billing) with an adequate fund of knowledge to avoid critical mistakes that may cost your startup tens or even hundreds-of-thousands of dollars.
- Stability: Yes, a biller at PV Billing may leave, but that’s a completely different situation than if your own single employee biller resigns. From your end, you may not even notice, as an equally-expert urgent care biller can simply step up and take over your billing.
- Contracting: Other billers may have some experience in contracting with payors. But how much experience do they have in urgent care contract negotiations? At PV Billing, for example, we don’t just have some people with some experience, we have the only staffers in the USA that work full-time on contracting and credentialing for urgent care. They negotiated over 100 contracts just last year. Chances are they have already negotiated a contract with the regional managed care representatives, and chances are that they will be able to negotiate a better contract with those representatives because of that relationship and that experience.
- Success: Practice Velocity never initially planned to get into the business of providing urgent care billing services. But we quickly found that for all the reasons above startup urgent care centers were struggling and even failing unnecessarily because they did not have an expert urgent care biller. They had a great tool (PV software) but they did not have a great skilled biller. In response to their need, we converted our billing department (using our staff who were already expert billers at Physicians Immediate Care) into our billing company PV Billing.
Click here to learn more about our expert urgent care billing service at PV Billing. |
