Urgent care facilities are essential for providing patients in need with life-saving medical attention. They are a more convenient alternative to emergency rooms and can treat a wide range of medical conditions. Managing the billing and coding process in an urgent care setting, on the other hand, can be a complex and difficult task.

With so many codes to choose from and insurance policies constantly changing, it’s critical to thoroughly understand the process. This is where the significance of Urgent Care billing and coding becomes apparent. In this blog, we will provide a comprehensive guide to Urgent Care billing and coding for 2023.

Whether you’re a medical billing company, a healthcare administrator, or a patient, this blog will provide valuable information on the latest updates, the process, guidelines, service levels, and CPT codes in Urgent Care billing and coding. Get ready to dive into the world of Urgent Care billing and coding and stay ahead of the game in 2023!

What is urgent care billing and coding?

The process of assigning codes to medical services provided to patients in an urgent care setting and submitting claims to insurance companies for reimbursement is called urgent care billing and coding.

This process employs codes from standardized coding systems such as Current Procedural Terminology (CPT), the Healthcare Common Procedure Coding System (HCPCS), and the International Classification of Diseases (ICD) (ICD-10).

Accurate billing and coding are critical for ensuring that patients receive proper reimbursement for medical services and that the urgent care facility receives payment for the services provided.

The urgent care billing process: Key Steps to Streamlining the process

The Urgent Care billing process may appear daunting at first, but with a clear understanding of the steps involved, it can be simple and efficient. Here is a step-by-step guide to Urgent Care billing:

Patient Registration

The first step in the Urgent Care billing process is to register the patient and collect their insurance information. This includes double-checking their insurance coverage and making sure their policy is up to date.

Medical Evaluation

Following registration, a healthcare provider will perform a medical evaluation and diagnose the patient’s condition. This evaluation serves as the foundation for the coding process and is critical for assigning the correct codes.

Coding

Once the medical evaluation is complete, the healthcare provider will assign codes to the services provided to the patient. This includes codes for the evaluation and management of the patient’s condition, any diagnostic tests or procedures performed, and any medications prescribed.

Claims Submission

The next step is to submit a claim to the patient’s insurance company for reimbursement. This involves submitting a bill that includes the codes assigned to the services provided and any supporting documentation.

Payment Processing

After submitting the claim, the insurance company will process the payment. This includes verifying the patient’s insurance coverage and reviewing the claim to ensure that all codes are correct.

Follow-Up

The final step in the Urgent Care billing process is to follow up with the insurance company to ensure that the payment has been received. If there are any issues with the payment, the Urgent Care facility will need to resolve them to ensure that they receive the correct reimbursement.

Urgent Care facilities can streamline the billing process and ensure that they receive payment for the services they provide by following these steps. Urgent Care billing and coding can be a simple and straightforward process with a clear understanding of the process.

S9088 and S9083 Urgent care Billing and Coding Guidelines

S9088 and S9083 are codes used in the Healthcare Common Procedure Coding System (HCPCS) to describe specific medical services and procedures.

S9088 is a code used to describe a service or procedure that is provided to a patient in an Urgent Care setting. This code is used when the patient requires evaluation and management services, such as diagnosis, treatment, and referral to other healthcare providers, if necessary.

S9083 is a code used to describe a service or procedure that is provided to a patient in an Urgent Care setting, but that is not covered by the patient’s insurance. This code is used when the patient is self-pay or uninsured, or when the service provided is not covered by the patient’s insurance policy.

Unlocking the mystery of service levels

Urgent Care billing codes can be confusing, especially when it comes to understanding the different levels of service and their corresponding Current Procedural Terminology (CPT) codes.

To help simplify the process, it’s important to understand the three service levels and their respective CPT codes.

Level I/Triage Care (Minor Problems)

Patients who receive evaluation and management services without any diagnostic testing are classified as Level I. CPT codes 99201 to 99202 and 99211 to 99212 fall under this category.

Level II/Intermediate Care (Moderate Problems)

Level II patients receive evaluation and management services, as well as injections and vaccines. CPT codes 99203 and 99213 are Level II services with a higher reimbursement rate than Level I services.

Level III/Complex Care (Severe Problems)

Patients receiving complex care, such as IV infusions, sutures, and E&M therapies, are classified as Level III. CPT codes 99204–99205 and 99214–99215 are Level III services with the highest reimbursement rate when compared to Levels I and II.

The Benefits of Outsourcing Urgent Care Billing: Why It’s Time to Let the Experts Handle It

Urgent Care facilities have a lot on their plate. From providing top-notch medical care to managing patients’ medical records and billing, the daily tasks can be overwhelming.  Letting experts do your job is a smart move.

The benefits of outsourcing urgent care billing are:

• Increased accuracy.
• Time-saving.
• Cost-effective.
• Improve cash flow.

Final notes

MDVitals provides a comprehensive medical billing solution designed specifically for Urgent Care facilities. With 24/7 customer service and transparent, cost-effective pricing, you can rely on MDVitals for streamlining the Urgent Care billing process. By partnering with MDVitals, Urgent Care facilities can reduce the burden of billing and focus on providing quality medical care to their patients. Contact us now for urgent care billing services.