Billing Challenges Faced by Freestanding Urgent Care Centers

Serving the needs of health care providers and centers, New England Medical Billing (NEMB) helps ensure accurate, timely cost reporting of ambulance services. One critical aspect of New England Medical Billing’s service is meeting the complex challenges faced by urgent-care centers.

Freestanding centers have come to prominence in recent years with a shift in health systems toward outpatient care. Unlike freestanding, or hospital-based, emergency departments, they serve as walk-in clinics outside of traditional emergency departments.

Required to comply with multifaceted coding and billing guidelines, freestanding urgent-care centers do not possess the unique set of CPT (current procedural terminology) codes that freestanding emergency rooms do. Instead, they must be aware of the specific office visit E/M (evaluation and management) codes they are able to employ when billing for services.

In addition, each payer can have separate contracting requirements that make provider credentialing and enrollment complex. These span copayments, deductibles, and patient referrals, and only grow in complexity each year, as payers create new and diversified consumer-focused products.

The role of companies such as NEMB is to assist providers and centers in staying on top of coding and regulatory challenges. The firm has a core commitment to ensuring that front-end staff can easily integrate billing functions within daily routines.

Ensuring Accurate Demographic Data in Medical Billing

An administrative services enterprise with HIPAA-compliant procedures, New England Medical Billing emphasizes a multi-disciplinary approach to system and program design. As featured in the New England Medical Billing blog, one major area of the firm's focus is in ensuring accuracy and efficiency through capturing the correct patient demographic and insurance information.

Common reasons for incomplete data include typos and misspellings, as well as emergency situations in which the patient is unconscious and there is no way of obtaining information such as his or her name or birth date. The emphasis, as it should be, is on providing timely care that may ultimately save a life. 

Unfortunately, this situation can lead to major issues down the road, as municipalities contend with lack of information when submitting claims to insurance providers. This in turn often leads to denial. A “self pay” designation is not ideal either, as reimbursement rates for self-payers can be much less than those provided under “fee-for-service” designations. 

A best practice involves billing vendors working toward the best interests of municipalities in creating IT-integrated relationships with local hospitals. This process ensures that data is entered directly into hospital health information systems, with information gaps being addressed the moment they occur and the direct billing of patients only taking place in cases of last resort.