Urgent Care Billing Services

E/M levels, S-codes and in-house ancillaries, billed at the rate your contract actually specifies.

Urgent care is paid two different ways, and the contract decides which. Either a global per-visit S-code, or standard E/M plus each ancillary. Billing the wrong model for a payer is the biggest revenue leak in this specialty. It is also invisible until someone compares the remittance against the agreement. Our urgent care billing services hold the contract terms per payer and bill to them.

Centres weighing up billing for urgent care services should also ask about clinician turnover. A new provider needs enrollment and linking to the group contract before their visits are billable. Let the roster go stale and you get denials nobody can appeal afterwards.

Our Services

Billing That Keeps Up With Your Clinic

Urgent care moves fast, so the billing has to move fast too. We do not need to list everything that matters in urgent care billing services. What matters is that you get a quick response and the work is still done properly.

That holds whatever procedures your clinic offers. Our urgent care coders and billers have spent years on cases like yours, and that experience shows up in your collections.

What benefits are provided by our Urgent Care Coding and Urgent Care Billing Services?

  • Comprehensive Quality Assurance

    There is no distinction between your practice and our billing and coding company. While you provide satisfaction to your patients through your services, we ensure your contentment by maintaining Accounts Receivable (AR), collecting claims, and ensuring timely submissions through meticulous fact-checking.

    Orbital Optimization

  • Orbital Optimization

    Billing and coding form the core of our services, encompassing a multitude of additional advantages. These benefits extend to focusing on your core competencies, reducing fatigue, enhancing service delivery, engaging more stakeholders, and, most importantly, optimizing revenue streams. These collective elements contribute to the flourishing success of a practice, even in challenging circumstances.

    Procedures icon

Procedures

As an all-encompassing urgent care billing and coding company, we address every procedure, ensuring complete compliance on our part.

  • Flu
  • Casts
  • Splints
  • Blood Pressure
  • X-Rays
  • Skin Lesion Removal
  • Stitches
  • Urinalysis

How urgent care gets paid differently

Urgent care sits between a physician office and an emergency department, and its billing borrows from both in ways that catch new centres out.

Place of service changes the payment

There is a specific place of service code for an urgent care facility, and using it or not using it changes what the claim pays. Some payers reimburse an urgent care visit at a higher rate than the same visit in an office. Others contract urgent care separately and will not pay an office claim at urgent care rates at all.

Check what each contract actually says about place of service before the first claim goes out, because this is a setup decision that repeats on every encounter until somebody notices.

Global case rates

Several commercial payers contract urgent care on a global case rate rather than fee for service. One code covers the visit and everything routine that goes with it. Under that arrangement, adding line items for the tests does not add revenue, and leaving out the code that triggers the rate loses the whole claim.

A centre with a mix of case rate and fee for service contracts needs the billing rules split by payer. This is the single most common reason an urgent care centre's collections do not match its volume.

After hours and weekend codes

There are codes for services provided outside normally scheduled hours, on weekends, and on holidays. They are billed in addition to the visit. Many payers do not pay them, and some pay them well. A centre open late and on Sundays should find out which of its payers does, because that revenue is being earned and not claimed.

Procedures inside a visit

Laceration repair, splinting, foreign body removal and incision and drainage are procedures with their own codes and their own global periods. When one is performed, the visit is separately billable only when there was a distinct evaluation, with modifier 25 and a note that stands without the procedure in it.

Applying that modifier to every visit with a procedure attached is the pattern payers look for.

Urgent Care Credentialing: Facility and Provider Enrollment

Urgent care credentialing is two jobs, not one. The clinic itself enrols as a facility, with its own tax ID, place of service and payer contracts. Every clinician then enrols individually and gets linked to that group contract. Miss the link and the claim is billed under a provider the payer does not recognise at that site.

Staffing makes this harder than it sounds. Urgent care runs on locums, part-timers and NPs and PAs who move between sites. Every one of them needs to be enrolled and linked before their first shift, and terminated when they leave. A roster that drifts out of date is the most common cause of urgent care denials we see.

We handle the facility enrollment and the clinician roster together. See our medical credentialing services.