Insurance billing is a vital part of your Urgent Care medical practice, and if you make mistakes in this area, you’ll be costing your practice a ton of money and jeopardize its success. While we have covered mistakes in urgent care billing before, there are still other mistakes to avoid, and we want to cover them with you. Here are some additional errors to be aware of in urgent care billing.
Not Following the Right Credentialing Guidelines
There are some people who believe credentialing and contracting are one and the same. This is not the case; however, as they follow different processes.
Credentialing is a process that involves payers verifying the qualifications and expertise of providers, which helps keep patients safer. Different payers have different requirements for credentialing, and even if a payer did not require credentialing of any kind, it would still be a mistake to make the assumption that you don’t need credentialing at all.
Payer contracts alone won’t be sufficient unless you already have facility contracts. Keeping payers and providers connected is a must in order to have claims processed properly. This is why you should bring in the help of a professional credentialing company that is able to help you work through the requirements of payer credentialing.
Committing “Locum Fraud” On Accident
Whenever outside providers do temporary work at clinics, questions about the right billing procedures to follow will often pop up. Even if mid-level nurse practitioners and providers are from locum agencies, it doesn’t necessarily mean that you can bill them using locum regulations.
To clarify, locum tenens are physicians that cover for other physicians. In certain situations, the pay for mid-level providers could be lower than what physicians would get, so you can’t bill these providers as if they were physicians.
If you make this mistake, you could get reimbursed for a greater amount than you’re supposed to get, and you would be committing an act of fraud. To avoid this error, physicians should only ever get billed as locum tenens.
Filling Out Claims Improperly
It can be complicated getting claims filed the right way, and you could either include too much information or not have enough. Leaving out critical information or adding information that is not necessary can both cause claims to get denied.
To avoid this kind of problem, it’s in your best interest to hire an urgent care billing company. They will know precisely what information is needed when filing claims so that your practice doesn’t receive denials and lose revenue.
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