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Mistake #14 — Ignoring Urgent Care Billing

An investment in knowledge pays the best interest
— Benjamin Franklin

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 billing for an urgent care startup:

  • 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 the particulars of urgent care billing? The answer is simple; you can’t. You have to focus on a business plan, pro forma, floor plan, building codes, signage, marketing, lines of service, patient complaints and a hundred other business items.

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You will never succeed, however, 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 United States. 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 cannot 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 fulltime employee.
  • Expertise: Rarely can an urgent care center find a single urgent care billing specialist (let alone the more than 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 payers. 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 country that work full-time on contracting and credentialing for urgent care. They negotiated more than 100 contracts just last year. Chances are they have already negotiated a contract with the regional managed care representatives, and most likely 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. We quickly found, however, that for all the reasons above, startup urgent care centers were struggling and even failing unnecessarily because they did not have an expert 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 that was already expert billing for Physicians Immediate Care) into our billing company PV Billing.