Urgent Care Billing
Our suite of Urgent Care RCM services
Patient Registration
The process commences when a patient arrives at the urgent care center seeking medical attention. During registration, demographic and insurance information are collected. Accurate and up-to-date patient data is vital to initiate the billing process smoothly.
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Documentation and Medical Coding
Following patient registration, healthcare professionals document the patient's medical history, examination findings, and treatment plan. Medical coders then translate this information into standardized codes, such as Current Procedural Terminology (CPT) codes and International Classification of Diseases (ICD) codes. Accurate coding ensures that the care provided is accurately represented for billing purposes.
Charge Capture
Charge capture involves recording all billable services, procedures, and supplies provided during the patient's visit. This stage requires close coordination between clinical staff and billing personnel to ensure that no billable items are missed.
Claims Submission
Once the documentation and coding are complete, the billing team compiles the information into claims and submits them to insurance carriers or third-party payers. These claims outline the services provided, associated codes, and costs incurred.
Insurance Verification
Insurance verification is a critical step to ensure that patient insurance coverage is active and valid. This step occurs before claim submission to minimize the risk of claim denials due to coverage issues.
Payment Processing
After the insurance carrier reviews the claim, payment is issued based on the covered services and the terms of the patient's insurance policy. Payments can include reimbursements for medical procedures, diagnostic tests, and other billable services.
Denial Management and Appeals
In cases where claims are denied, the billing team initiates a denial management process. This involves identifying the reasons for the denial, rectifying any errors, and resubmitting the claim or appealing the decision if necessary.
Patient Billing and Communication
Patients receive statements detailing the services rendered, insurance payments, and any outstanding balances. Clear and transparent communication about costs, coverage, and payment options is essential for maintaining patient satisfaction and minimizing disputes.
Reconciliation and Reporting
Reconciliation involves matching payments received with the services provided and documented. Accurate reconciliation ensures that all payments are accounted for and any discrepancies are addressed promptly. Reporting provides valuable insights into the center's financial performance and RCM efficiency.