Today in the world of healthcare, options are expanding. And the growing demand of urgent care specialties says it all for its prompt and cost-effective medical attention. In fact, today urgent care clinics are gaining popularity primarily due to their ability to provide quick and affordable healthcare services. Reduced wait times at urgent care facilities address the frustration of patients who need immediate assistance. With an average wait time of around half an hour, urgent care centers is no doubt a timely alternative to traditional healthcare settings.
While the demand for urgent care services is on the rise, billing and coding errors are a significant cause for revenue losses for many urgent care clinics today.
Understanding urgent care guidelines:
Billing for urgent care shares similarities with primary care, given that both treat similar conditions. However, there are specific Current Procedural Terminology (CPT) codes, marked with an "S," that are unique to urgent care. Notably, S9083 and S9088 are two essential codes applicable for all urgent care services, excluding Medicare.
Code S9083: Bundles all services provided during an urgent care visit into a single payment code, regardless of the treatment procedures involved. Managed Care Organizations (MCO) often require hospitals to bill under this code for services in specific regions.
Code S9088: Designed for situations where practitioners provide immediate care with minimal waiting times. This code, when used along with appropriate evaluation and management codes, ensures reimbursement for the services provided.
The Most Common Urgent Care Codes that are In Usage:
The majority of CPT codes used in urgent care fall under Evaluation and Management (E/M) codes. Some of the commonly used codes include:
Level 4 E/M (99204): Utilized for new patient visits based on the level of care provided.
Level 3 to Level 4 E/M (99213 and 99214): Applied for established patients based on the level of care provided.
Revised CPT Codes In Urgent Care:
Compliance with the Centers for Medicare & Medicaid Services (CMS) rules and regulations is crucial for successful claim submission. CMS reforms have influenced code changes in urgent care billing. Notably, the face-to-face time requirement for CPT codes 99202/99215 has been modified to the total time spent on the day of the encounter.
With all these confusion to remember, even though managing a practice and handling billing in urgent care may seem straightforward, but the complexities involved can be draining. To avoid revenue loss and ensure compliance with ever-changing rules, today outsourcing Revenue Cycle Management(RCM) functions becomes essential. This is where Sunknowledge Services Inc. decades old RCM fits in. Offering comprehensive RCM services, Sunknowledge caters to all your urgent care billing needs. Taking care of your coding, billing, claim submission Sunknowledge allow you to focus entirely on patient care. With a commitment to providing real-time solutions, Sunknowledge experts prioritize the success of your practice in the evolving landscape of healthcare billing.
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