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Understanding Compensation Rules in Urgent Care Billing

by williemsmith
urgent care billing

Reimbursement caveats under Urgent Care billing

As with all other forms of health care billing, Urgent Care billing aims at ensuring maximum reimbursement by the patient’s health plan. However, health plans seldom come with 100% coverage. There is often a limit to which insurance companies would agree to pay for medical services provided. There are also other factors that can impact the final collected amount, such as co-pays, deductibles, the provider being in-network or out-of-network, pre authorization and so on. It is important to understand all these aspects to arrive at a realistic estimate of how much a provider will be finally compensated for.

A co-pay, for example, is a payment that is specified in the health plan and is paid by the insured person every time a medical service is obtained. A deductible, on the other hand, refers to an amount that the patient must pay for health care services received before the health insurance starts paying. Receiving medical services from an in-network provider means that the patient can access care at lower prices and the provider agrees to accept the insurance payment for covered services as payment in full.

Reducing confusion and maximizing collections

As is evident from the above, there is a lot to take into account when one is trying to ensure the maximum reimbursement. It often happens that revenue which is rightfully due to the provider, falls through the cracks and is lost forever. To reduce errors, manage denials and secure the maximum reimbursement, a growing number of practices across the U.S. are engaging professional assistance in their billing and collection affairs.

Yes, outsourcing of key billing services (and sometimes, the entire revenue cycle) to professional and dedicated third-party billing experts is being embraced by more and more providers in every conceivable specialty. Besides bringing about a noticeable improvement in the revenue generation area, strategic outsourcing can also help lower operational cost and free up in-house resources to pursue more important tasks. What’s more, these specialized billing agencies use highly streamlined processes that help to get more done than a typical, in-house back-office team.

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