• June 19, 2024

How to Control Coding Challenges in Urgent Care Billing?

 How to Control Coding Challenges in Urgent Care Billing?


The number of Urgent Care centers is rapidly increasing as the healthcare industry expands. Their popularity comes from their capacity to deliver speedy, low-cost, and efficient medical care. Urgent Care Billing is more challenging than other medical billing scenarios due to the fast-paced environment and unpredictability of patient flow.

Here are some frequent problems to keep in mind. For example, due to a coding error, you may have to bill twice for the same medical service. Billing information entered by more than one person aggravates the situation. You should double-check patient billing information and prohibit numerous coders from entering billing details to avoid double billing.

What is Urgent Care Billing?

It covers the whole claims-filing procedure, including verifying that all supporting data is correct and that medical necessity exists. Urgent Care Billing is a difficult procedure. While the methods are comparable to primary care billing, the coding and billing processes are not identical. Any hitches in the process might have an adverse effect on your revenue cycle management. Outsourcing your Urgent Care Billing Services can help you streamline the process, minimize redundancies, and enhance collections, allowing you to devote more time to patient care.

It is common to charge for urgent care services using the code S9088. Urgent Care can bill for their examination and treatment services using this code. While these treatments are frequently more expensive than non-Urgent Care services, this code can assist Urgent Care in receiving reimbursement for those higher expenses. If the incident isn’t life-threatening, Urgent Care can bill for a medical evacuation.

It is necessary to follow the urgent care billing and coding rules. For example, if an Urgent Care provider fails to pre-authorize the patient’s insurance, the claim is more likely to be rejected.

  • Urgent Care Coding Regulations


If you own an Urgent Care facility, you’ve probably already heard about the American Medical Association’s new code set. This is the first major makeover in twenty-five years, and it focuses largely on outpatient assessment and management services, which are the primary revenue drivers for Urgent Care facilities. It, for example, did away with the history and physical exam codes. It enabled clinicians to choose based on the time the patient was seen, allowing billing offices to charge greater charges.

Except for the Urgent Care code, the billing method for Urgent Care services is comparable to that of primary care practices. To minimize bottlenecks in revenue cycle management, both the billing and coding processes must be precise and compliant. Here are some pointers to get you started if you’re not sure where to start.

The Urgent Care Coding Regulations are a complex set of requirements, and many Urgent Care facilities did not have the time to adapt their systems to the modifications. Using Category 1 CPT codes is an important element of Urgent Care Billing. Most Urgent Care Medical Billing services use these codes. The most popular category, in general, is 99214, which is more difficult and reimburses more. Another classification is 99204, which is the most commonly used code for new patients. This code necessitates a detailed history and examination, as well as moderate medical decision-making. This code is well reimbursed and has a minimal risk of noncompliance.

0 Limited Time to Confirm Insurance

When selecting an Urgent Care facility, keep in mind that many will accept your insurance. This way, you may keep your out-of-pocket expenses to a minimum. If you don’t have insurance, you may still utilize a site like Solv to check prices and arrange a hassle-free appointment.

Prior Authorization for Urgent Care Billing

The capacity to bill more than a primary care office is one of the most difficult aspects of Urgent Care Billing and Prior Authorization. Urgent Care may bill for treatments using higher S codes to reflect the greater treatment costs after hours. However, because CMS may not pay Urgent Care for certain treatments, invoicing and prior authorization errors may cause reimbursement to be delayed. To minimize misconceptions, Urgent Care should be familiar with correct billing and coding standards.

While Urgent Care coding requirements are similar to those for primary care, they are frequently different. An Urgent Care coder must assess whether codes are acceptable for various medical procedures while also adhering to insurance provider guidelines. It is likely that an Urgent Care practitioner will be unable to submit a claim if they do not obtain pre-approval from an insurance company before billing for treatments. Additionally, most Urgent Care providers don’t have the time to call insurance companies for coverage confirmations. Without pre-authorization, a denial can significantly affect a practice’s revenue.

o Centers for Medicare and Medicaid Services Regulations

If you want to file a bill for a patient who was seen at an Urgent Care center, you must first understand the Centers for Medicare and Medicaid Rules for Billing and Coding of Urgent Care Services. These standards dictate how a doctor must bill for Medicare-covered treatments. If the patient has not previously gotten professional care within three years, the doctor should apply a code for such an issue. It is essential to correctly capture and submit these codes as medical records.

How does NEO MD Medical Billing Assists Urgent Care Physicians to ensure practice workflow?

Medical Billing is undergoing fast changes as a result of the No Surprises Act and current state legislation. Switching to third-party Revenue Cycle Management companies has never been more advantageous.

NEO MD provides unmatched Urgent Care Billing and coding services in all 50 US states. Our billing services are tailored to the demands of the physician specifically and compliant with the mandatory Coding rules for a quick and efficient claims processing procedure. Furthermore, our Revenue Cycle Management services are frequently updated with relevant CMS rules.

Additionally, NEO MD offers the Best Medical Billing Services in terms of quality and value to assist in efficient cash flow and revenue. We provide affordable billing services with No Hidden charges.

What Makes NEO MD the Best Urgent Care Billing Services Company?

NEO MD stood best among competitors due to ensuring the latest CMS Medical Billing and coding guidelines; 

  • First level of Claim acceptance rate 95-98%
  • Our experts work hard to reduce your front-end denials by 20%
  • Improve RCM system efficiency with a robust credentialing team 
  • Offer internal Medical Billing audits to uncover loopholes
  • Offer Provider & Staff Productivity Analysis
  • Provide fortnightly financial and practice overviews F
  • Refunds adjustment and Payment posting to improve the cash flow
  • Evolving state-of-the-art medical billing services for small practices
  • Identify potential under, over, and incorrect coding scenarios
  • Deliver customized Revenue Cycle Management Services to unearth operation shortcomings
  • Out of Network Negotiations
  • We have consistently increased the collection rate for our clients because of the faster increase in the accuracy of fees and collection
  • Provide Urgent Care Billing services that are of high quality and error-free

Let’s Schedule a Demo to learn more about how we can improve your medical practice management. Get us at! (info@neomdinc.com) or (929) 502-3636).



Shabbir Ahmad


Shabbir Ahmed is a professional blogger, writer, SEO expert & founder of Dive in SEO. With over 5 years of experience, he handles clients globally & also educates others with different digital marketing tactics.