Urgent Care Medical Billing

How to Improve Medical Billing Profit Margin via Urgent Care

The patient always visits a related physician to get treatment for whatever illness they are dealing with. On the other hand, a physician always attends to them and performs tests and processes to restore their health.

However, the more patients flow in a healthcare center, hospital, or clinic, the more will be the cash flow, and this enhances the medical billing profit margin.

It’s a common fact that a provider’s professional growth and prosperity are dependent on the efficiency of the billing and coding units that they hire for themselves.

The primary causes of outsourcing for fulfilling all billing requirements and dealing with the revenue management cycle are;

  • Minimizing the overhead of a provider e.g., setting them free to deliver their specialized services as a physician to their patient leaving the rest of the tension of RCM on the billing team Get the reimbursements on time without subsequent delays
  • Raise the overall medical billing profit margin

The first two expectations from a medical billing and coding team are quite obvious that must be fulfilled. But what if providers do not get the suitable medical billing profit margin they expected to achieve? Several queries immediately pop up in one’s mind after this:

  • What can they do in such a condition?
  • How could they overcome the loss?
  • What might be the cause behind this?

Here, we can easily coin the reason behind the financial leakage these providers will face or are facing. Giving a miss to urgent care medical billing or compromising over the urgent care services could be a reason.

Let’s get familiar with urgent care and the influence of urgent care profit margins on a provider’s financial status.

Why Consider Urgent Care for Improving Medical Billing Profit Margin?

Urgent care is the hands-on choice for all those looking for affordability along with quality for the medical services they need to deal with any ailment or condition.

Urgent care units are usually open seven days a week with no prior appointments and have low service charges as compared to any ER visit.

What is the tragedy with urgent care units is that they have:

  1. Insufficient no. of expert billers and coders
  2. Limited access to resources to handle urgent care billing
  3. Higher cost of operations with lackluster productivity standards

When we foresee these problems, we come to know how urgent care billing difficulties can disturb the overall medical billing profit margin for urgent care providers.

Outsourcing Urgent Care Medical Billing is Highly Recommended

A smooth revenue cycle and on-time reimbursement greatly rely on a quick and accurate claim process. And when you outsource the billing service, it will help you maximize resources and ultimately your medical billing profit margin will increase.

Listed below are some things that with convince you to urgent care medical billing from a third party:

  • You may take care of your billing needs round-the-clock without worrying about an employee being absent for any unforeseen reason when you outsource your billing services.
  • Your staff won’t have to worry about juggling multiple tasks thanks to outsourcing, which will enable them to focus entirely on patient care.
  • You may relieve yourself of the responsibility of informing your patients of any unpaid debts.
  • You can save money spending on billing software, and in-house billing and coding team’s salaries. Also, no need for extra working space that is usually required for an in-house billing team.
  • Because it is more practical and approachable, urgent care also opts to outsource its billing function. The reason for this is that the outsourced billing agent will handle all data input for the claims and rejections, patient data, reminders, and sending bill reports to patients. Data transfer has improved with EHR interoperability.
  • It enables your in-house team to provide patient-focused services and compassionate care which ultimately brings in more patients and encourages current ones to keep choosing you whenever they need any medical assistance.
  • You can avoid various monetary penalties by maintaining compliance with regulatory requirements and minimizing errors in your urgent care billing and coding procedures.
  • You can practice streamlined urgent care operations at every step with an increased urgent care profit margin.

Urgent Care Facility

A provider deals with several types of patients every day. However, those with life-threatening conditions require intensive care and on-time treatment. Otherwise, they might lose the battle of life. Therefore, the Centers for Medicare and Medicaid took an initiative in 2003 and dedicated POS – 20 (Place of Service – 20) as a designation for an urgent care facility. It is a unit or department apart from an ER room.

An urgent care facility might be any doctor’s office, clinic, or a place where medical providers attend to patients with minor to severe illnesses, infections, tumors, injuries, and other conditions without any prior appointment at cheap prices. Whereas, an ER is only meant to attend the critical life-threatening ambulatory patients 24 hours a day without any delay. Anyhow, it charges a high revenue fee from the patients.

How to Submit Claims via Urgent Care Billing Process

CMS has efficiently covered the gap between primary care services providers and emergency room facilities at a hospital. It has forwarded a clear set of guidelines for all the payers and insurance companies to manage their urgent care billing matters accordingly and increase their medical billing profit margin. CMS binds all urgent care facilities to strictly employ POS-20 if the contract language is absent.

In addition to this, all urgent care facilities have the option to either sign a contract or make their bills for the services they have catered to their patient at a doctor’s office. All such bills are covered under the POS – 11 urgent care billing code by CMS. However, they can only use POS-11 if the operating circumstances of the healthcare market permit it.

Over the previous several years, the urgent care facility has scored substantial fame and recognition. Now, its value is predicted to reach over $26 billion by the end of 2023. Being in control of billing processes will enable you as a medical professional to boost and optimize workflow for the highest potential returns.

Urgent Care Billing Starts Spinning from Front Desk

The urgent care billing cycle, which begins at the front desk, is crucial. Dealing with the RCM in the rest of the process for any billing and coding team. Therefore, we have an easy way out to facilitate all of them in their billing and claim submission process.

We can effectively introduce smart financial policies when we handle the patients coming to the front desk at first. The medical receptionist sitting at the front desk not only sits at the front desk for welcoming new patients but also guides them and collects the appropriate information for them as a part of the process, registration process.

The Registration Process

There is no system of pre-visit appointments at urgent care facilities; instead, patients can receive medical attention immediately. If a patient had a walk-in appointment, they would still need to supply some basic information at the front desk as a part of the process, called registration.

Some examples of this data are;

  • Patient’s demographic Data
    • Name
    • Address
    • Birth Date
    • Residence
    • Medical History
    • And much more
  • Payer’s Related Data
    • Insurance Company
    • Policy Number
    • And much more

The medical attendants complete the registration process in the first step and later utilize it for keeping EHRs. EHR is a digitalized method of storing the patient’s information electronically so that it can be easily accessed at the time of need with a few clicks.

Following the patient’s admittance to the urgent care facility, the healthcare professional and staff work to update the EHR with the notes, prescribed treatments, patient’s health status, doctors’ advised procedures, prescriptions, and much more.

The urgent care billing procedure is made significantly simpler with an updated EHR that has complete and up-to-date information.

Provide Required Financial Responsibility Information

The staff is overly preoccupied with making patient arrangements at an urgent care facility. To verify the health insurance policies that clients specify at the front desk, they are not always accessible. Typically, private clinics and hospitals are in charge of this pre-authorization service.

Patients must be fully informed about their insurance policies to do this, including whether they are covered for walk-in or emergency medical appointments. Because of the staff’s excessive workload, patients must sign a form agreeing to assume financial responsibility before receiving medical treatment.

Active Follow up with patients

Every medical facility’s front office is required to update, record, and contribute the relevant data to the EHR, regardless of where the patient received their medical care. The information entered into the EHR makes it easier to create correct invoices, submit claims, and get money back from patient insurers. Thereby, they actively connect with the patients and the payers to update them from time to time.

Claim Submission

The billing and coding team carefully reviews and ensures compliance with the necessary federal or CMS criteria throughout the medical process. Sending the claims to the insurance company is the last step in the billing process.

Every detail about the surgery a patient has insured from a certain doctor or hospital facility is included in the claim or the bill that the insurance company receives. Additionally, the claim contains details about the associated fees, the diagnosis, and the operation. Complete and on-time compensation for the provider will be guaranteed by an accurate claim that is error-free and complies with all regulations.

Most providers employ electronic claim submission software, which authenticates every detail they offer, to speed up the lain processing process. Usually, electronic software will assist providers in accurately recording patient data for claim payments.

Urgent Care Billing and Medicare

The services obtained from urgent care are not likely to be covered by the Centers for Medicare and Medicaid Services, or CMS. That’s why it is always challenging for providers to receive timely compensation.

Usually, when a patient goes to an urgent care center, the staff or the physician is unclear about how long the treatment will take and what post-visit medical services the patient might need. Due to the S codes’ recognition of the necessity for more expensive medical treatment, billing for urgent care is therefore permitted to exceed estimates.

For urgent care claims, Medicare uses the code S (POS-20). Although they continue to treat it as primary care and utilize the codes POS-10 and POS-11. Medicare officials do not let the code prevent them from treating it as urgent care.

Urgent Care Billing and Medicaid

Medicaid primarily pays for the treatments obtained through urgent care, but they still do not process the invoices for these services, which are delivered during walk-in appointments and come at a high cost by nature. Providers must thus increase the number of patients with private insurance if they want to optimize profit and maintain the revenue cycle.

Which Option is Suitable for Urgent Care Medical Billing?

There are two key approaches to consider for the effective management of urgent care billing;

  • Have a Billing and Coding team on staff
  • Hire Medical Coding Professionals to handle the billing procedure

The cost of gathering software licenses and other process requirements will increase for both choices. Additionally, both options require thorough details about the billing procedure because they regularly monitor your financial claims.

However, Outsourcing your Medical Billing and coding is the most commonly used option among the two of them.

These are some of the primary explanations for why service providers are more likely to outsource their crucial jobs that will bind their organizations for an extended period.

Urgent Care Versus Primary Care: Advantages and Disadvantages

Let’s look at how patients feel about urgent care and primary care clinics now that we have discussed the situation from a provider’s perspective.

There are certain benefits and drawbacks to each, and the discussion that follows will help you and your family decide whether primary care or urgent care clinics are best for you and your family.

The Advantages

  • The primary benefit of urgent care facilities is that patients can just walk in and receive comprehensive medical care without making an appointment.
  • Units that provide urgent care don’t have set hours. Generally speaking, they are also open on weekends. As a result, you can get medical assistance at any time.
  • Additionally, you won’t have to wait as long in an urgent care facility as you would at a private facility.

The Disadvantages

  • If the family in need of emergency treatment is struggling financially, going to the ER will unfortunately be an expensive process. There would be immediate financial action taken if they had applied for debt and it would take some time for them to arrive. An ER would be twice as expensive as an urgent care facility.
  • The inability of urgent care facilities to offer life-saving treatment is one of its drawbacks. Patients must locate an emergency room for fast care in the event of an emergency medical issue, such as a heart attack or accident. Since an ER (emergency room) is reserved for such situations, urgent care clinics are unlikely to be able to treat you or a loved one if you are experiencing a medical emergency.
  • When you visit an urgent care facility, it’s possible that you won’t see the same doctor again for several months. The new doctor might not be familiar with your medical history. Even if the new doctor has access to all of the patient’s prior medical records, it is generally considered that the patient will not receive the same level of care.


For the treatment and services, a patient received, the billing and coding team follows the same process regardless of whether you choose an urgent care facility or a primary care physician. Compliance with the regulatory requirements is vital for providers, regardless of whether they outsource the billing or keep it in-house. However, you can considerably increase your medical billing profit margin by improving your urgent care billing system.

1 reply
  1. Thomas
    Thomas says:

    “What strategies can urgent care facilities implement to enhance their medical billing profit margin?”


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