Throughout the global pandemic, the urgent care billing industry in the United States has encountered numerous and unexpected financial hurdles. Urgent care clinics, like most industries, have had to pivot and modify their workflows to better navigate uncharted and unfamiliar ground.

It became increasingly challenging to negotiate the financial landscape and remain profitable while dealing with a dearth of affordable personal protective equipment (PPE) and extreme variations in patient visit volumes. Three issues have continuously plagued urgent care billing facilities over the last year and a half.

3 Major Urgent Care Billing Obstacles for Healthcare Providers

  • Compensation for testing and treatment

As a result of the pandemic’s economic ramifications, the United States’ unemployment rate increased to levels comparable to the 1930s. Unemployment rates neared 15% in April 2020. Many individuals and families became uninsured as their healthcare coverage was linked to employment.

In response to this widespread loss of coverage, the Health Resources and Services Administration (HRSA) established the Uninsured Patient Program Portal in April of last year to aid providers with claims reimbursement, generally at Medicare rates, for testing, treating, and vaccinating uninsured patients affected by this pandemic. During the first year of the epidemic, the program was critical because it allowed more people to get the urgent care they needed despite the loss of their insurance.

However, reimbursement for claims submitted through the site caused various issues for providers. Clinics were reimbursed at Medicare rates, but they frequently spent more money on patients than the covered rate. Finally, it was difficult to obtain the right identity and information for undocumented patients, and rejected or returned claims for these patients were difficult to address because there was no appeal process.

  • Healthcare rules and coding are always changing

During the epidemic, urgent care billing and coding standards were constantly changing, especially in the early months. As part of these ongoing developments, new CPT codes for documenting and invoicing pandemic related visits were introduced, and providers were compelled to implement telehealth systems to limit risk by remotely monitoring patient testing.

The healthcare paradigm, which had been widely followed for years, quickly became uncharted territory for providers. The learning curve, along with inaccurate claims due to new standards, resulted in more rejected or returned claims that required time to rework in order to attract proper reimbursement.

Retraining and modifying current systems to incorporate new codes took time that urgent care billing didn’t have as visit volume grew. Furthermore, guidelines differed across the continuum. Varying payers had different telemedicine requirements, resulting in contested claims and increased work for provider offices across the industry.

  • Patient misunderstanding about care coverage

Throughout the pandemic, urgent care billing centers felt the effects of patient confusion. Patients were terrified and unsure about so many things at once:

  • Virus exposure
  • Tele-health alternatives
  • Testing locations
  • Test eligibility
  • Pandemic service coverage

Aside from addressing the high demand for tests, clinic personnel had to answer more questions than ever before as consumers sought explanation and comfort from their local specialists.

While the government acknowledged that epidemic testing would be free for everybody, there were some details that were left out, such as changes in recommendations for basic screenings vs. testing those who had been exposed to the virus.

As a result, patients arrived at urgent care clinics anticipating free epidemic testing and care, but some were still charged according to their insurance coverage, causing dissatisfaction and urgent care billing problems.

As the urgent care sector adapts and evolves in response to the global health crisis, clinics must double down on sustaining healthy and sustainable revenue cycles despite the shifting market.

Sunknowledge Has the Complete Solution to Urgent Care Billing

Our client references and testimonies are excellent, and we serve the most populous areas in New York. Even during these difficult circumstances, we have remained consistent and have been able to lower their operational costs by 70%. As an urgent care billing powerhouse, we have also been successful and have boosted our business by 25%.

Hire us if you want a thorough makeover of your cash reserves. With a collection charge of only 1.99%, we ensure that all of your money is recovered on schedule. Contact us if you want to completely overhaul your pending bucket with our array of urgent care billing options.