The Top Billing Mistakes and How To Fix Their Root Causes (Urgent care

The Top Billing Mistakes and How To Fix Their Root Causes (Urgent care Image
By SYNERGEN Health October 26, 2021

As the healthcare landscape continues to change, urgent care centers continue to see explosive growth. Driving their popularity is their ability to provide health care services quickly, affordably, and efficiently. In fact, most urgent care facilities have a wait time that’s 30 minutes or less  and most visits take an hour or less. The urgent care market is so hot that private insurance claim lines for services offered in urgent care went up 1,725% between 2007 and 2016. Growth is expected to continue, with the market expected to hit $26 billion in 2023.

Although business is booming for the urgent care market, urgent care centers are in danger of losing a huge amount of money if they make billing and coding mistakes. Billing and coding mistakes don’t just cost a few cents – it can make the difference between a successful or unsuccessful center. Here’s a closer look at 5 most common urgent care billing and coding mistakes, as well as information on how to fix them.

Mistake #1 – Poor Front Desk Processes

Revenue cycle starts at the front desk, and urgent care centers often make the mistake of failing to have good financial processes that begin at their front desks. It’s important to make sure the staff is collecting co-pays at the beginning of patient visits instead of waiting until the end of their visit.

It is important to confirm current insurance information, identify potential billing problems up front and collect copay for a patient at the time of registration or before he/she leaves the clinic. The chance of getting this information later is significantly reduced. Not ensuring coverage combined with not collecting copays, reduces the chances of collecting a full payment. Following up with patients to get missing information takes time, and patients aren’t likely to be in a hurry to respond.

Prior balances should be collected before new services are provided to patient and paper work should be ensured as accurate before it heads to the billing department.

Failing to have good front desk processes in place can result in a slowdown in claims process, an increase in bad debt, lost revenue, and more patient accounts that end up in collections.

This risk can be reduced by financial processes for the urgent care facility that start at the front desk. Make sure the front desk staff members are well trained in all processes. It is recommended to have routine retraining for staff members to ensure everyone is up-to-date and following the standard processes.

Mistake #2 – Poor Contract Management

Setting up your contracts with payers involves entering a legal agreement with the payer in which they agree to reimburse the facility per the contracted fee schedule and market the facility as an in-network center in their network directory. Failing to set up contracts with payers means the facility won’t be able to accept insurance, making it tough to build patient volume required at least to break even. 

Negotiating poor contracts can be nearly as bad as having no contracts. The reimbursement rates negotiated must be fair, reflecting the full scope of services provided at the urgent care center. 

Insurance companies always want to lower their costs, so it can be an uphill battle to negotiation higher reimbursement rates. However, it is possible to renegotiate with payers to increase compensation rates. In many cases, hiring a contracting expert to take care of negotiations for the facility can be the best course or action, ensuring the best possible reimbursement rates to fuel practice growth. 

Mistake #3 – Failure to Follow Credentialing Guidelines

Credentialing and contracting processes are very different. Credentialing refers to the process used by a payer to verify the expertise, experience, and qualifications of a provider to ensure patient safety. Since every payer has unique credentialing requirements, don’t make the mistake of assuming that each payer’s requirements are the same. It’s essential to ensure that providers are credentialed with payers for the urgent care center so claims can be processed correctly.

Some of the credentialing problems that many medical facilities run into when going through the credentialing process include lack of timing, poor organization, poor workflow, failing to keep contact information up to date, and failing to check into state compliance. The best way to deal with this mistake is to hire credentialing experts that can work to properly navigate the credentialing requirements of each individual payer.

It is recommended to hire a credentialing expert who can help navigate payer credentialing requirements.

Mistake #4 – Incorrect Documentation or Under-Documented Record

Missing out on valuable charges can cost the urgent care big time, and the cause of missed charges is often incomplete documentation. It’s easy to forget to document a step, particularly if instructions have been verbally communicated. Some of the most commonly missed charges include x-rays, reading results, injections, blood draws, and labs.

Providers may also make the mistake of forgetting to document drug dosage amounts. The amount of dispensed drugs should be noted correctly so the correct charges can be submitted to payers. Poor documentation for the visit will result in delays in claim submissions or claim denials.


Once again, it’s helpful to remind providers of some of the most commonly missed charges. Using smart alerts in EMR system can offer reminders when providers are locking charts. Logging drugs dispensed and requested labs makes it easy to double check them against the claim charges in the future. Failing to document items in the right sections can result in accidental under-coding, which results in lost revenue for the facility. Providers also need to make sure they are documenting exams, history, and MDMs correctly within the EMR system so office visit codes reflect what was done during the visit accurately.

Billers should have a deep understanding of payer guidelines to ensure claims are clean. Having a coding specialist, whose job includes checking and verifying codes before they are submitted, can be a huge help in reducing errors, and ultimately getting paid accurately for the services provided.

Mistake #5 – Making Mistakes Filling Out Claims

Making mistakes when filling out claims is another big urgent care billing and coding mistake which needs to be avoided. It can be complicated to fill out claims and including unnecessary information or forgetting important information on the claim can result in a denial. Forgetting to add in code modifiers or using the wrong modifiers can make your claim result in a denial. Other coding mistakes can include illegible handwriting on forms, forgetting to add an important modifier, not documenting the National Drug Code (NDC) on the medical record in a specific format or failing to make a diagnosis code as specific as it should be.

One of the best ways to avoid mistakes on claims that cost you money is to go with an expert billing and coding service that can navigate all the intricacies of submitting claims to prevent denials. They will be able to ensure the practice gets as much money as possible from payers to keep the revenue cycle going strong staying compliant.

Top five common errors made by medical billers;

1. Not Enough Data

Failing to provide information to payers to support claims results in denials or delays. For instance, problems can occur if billing department employees don’t link a diagnosis code to the Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) code or don’t add a fourth or fifth digit to the diagnosis code.

Although employee error causes some of these mistakes, they can also occur if physicians don’t provide accurate diagnosis information.

2. Up coding

Up coding occurs when the documentation does not support the services provided.

Errors in correlating the correct diagnosis and treatment codes during charge capture can contribute to additional errors.

3. Telemedicine Coding Errors

Healthcare technology makes providing quality care to patients in multiple locations much easier, but it also complicates the billing process.

Incorrect use of modifiers for telehealth services results in payment delays. For example, the GT modifier applies to real-time telehealth services provided by audio or video systems, while the GQ modifier covers services provided through asynchronous telecommunications systems, such as an emailed X-ray.

4. Missing or Incorrect Information

Errors or omissions are a common cause of claim denials and can be easily prevented by double-checking all fields before submitting a claim. Incorrect or missing patient names, addresses, birth dates, insurance information, sex, dates of treatment and onset can all cause problems.

Although it may not happen often, sometimes information is accidentally entered in the wrong patient’s record. If billing employees only enter the information as provided and don’t investigate mismatches in treatments and diagnoses, a claim denial will follow. Unfortunately, in busy billing departments, these problems can be easily overlooked.

5. Incorrect Procedure Codes

A simple slip of the fingers can result in the incorrect entry of a procedure code. Information may also have been incorrectly documented on encounter forms or other supporting documentation. This will result in leaving money on the table. In addition, the claims submitted may be inaccurate, resulting in rework and delaying reimbursement.

2020 and 2021 were years of big change when it comes to E/M coding and regulatory updates. During the pandemic, new CPT codes were introduced to help clinics manage COVID-19 testing, telehealth visits and vaccine administration

To prevent reimbursement issues, hospitals must avoid medical billing and coding errors. Ongoing continuing education programs, as well as other informal training sessions on a regular basis can help ensure that employees are aware of the latest coding requirements and best practices.


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