Urgent care medical billing is a fast growing trend and medical billing for the urgent care is a unique and different method of medical billing. Let us start with the definition of "urgent care". By definition, urgent care is the delivery of ambulatory medical care outside of a hospital emergency department on a walk-in basis without a scheduled appointment. Here in the US today, there are more than 9000 urgent care centers and these centers function mainly after the regular office hours. It is meant for those patients who may require immediate attention without having the hassle of going into the emergency department of a hospital.
The Urgent Care Association of America (UCAOA) represents these many urgent care centers that provide appropriate and timely alternatives to the more costly and inconvenient hospital emergency departments. To take a look at the accredited urgent care centers go to http://www.ucaoa.org/accreditation/sites.html
Medical billing is the process of submitting and following up on claims to insurance companies in order to receive payment for services rendered. Medical billing/coding professionals working in the urgent care sector must have specialized knowledge in urgent care billing and also in the specific area medical coding. It is essential for medical billing services to do highly accurate billing at the same time keep the client’s outstanding accounts receivable as low as possible. What are these urgent care situations for medical billing? They include,
Services in the evening/weekend/ holidays Compensation for workers Services requiring urgent care/emergency services Removing foreign body from eyes Drug screening Breath testing for alcohol Injury in workplace/factories etc
Medical billing staffs for the "urgent care" have to be very careful about certain aspects while billing. The success of any urgent care facility depends on the correct coding, billing and tracking of payments. Quite often the urgent care centers employ physician assistants (PAs) or nurse practitioners (NPs). These are mid-level providers of services that are "incident to" a physician’s care. Such services given can also be fully reimbursed but realize that the Medicare payment rules are very precise for "incident to" services. These must be fully adhered to.
Most of the health plans today work only with specific laboratories. If an urgent care center is providing lab services, it may be necessary to have a CLIA (Clinical Laboratory Improvement Amendments) waiver. A CLIA waiver may limit the number of not emergency tests that can be done. If the urgent care center uses the services from an outside reference laboratory, the medical billers will have to make sure at the outset itself that the patient’s insurance plan will be able to cover those services.
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