Urgent care centres play a crucial role in the healthcare system, providing fast and affordable treatment for non-life-threatening conditions. With over 14,000 urgent care facilities across the United States in 2024, millions of patients depend on these centres for timely medical attention. However, managing urgent care billing effectively remains a challenge due to complex coding requirements, evolving insurance policies, and the risk of claim denials.
To maintain financial stability and maximize revenue, urgent care facilities must track key billing metrics, optimize reimbursement processes, and ensure compliance with industry regulations. In this blog, we’ll explore essential billing metrics, strategies to improve revenue cycle efficiency, and the benefits of outsourcing urgent care billing to enhance financial performance.
The Growing Importance of Urgent Care Billing Services
The U.S. urgent care centres market size was estimated at USD 34.34 billion in 2024 and is expected to grow at a CAGR of 8.6% from 2025 to 2030. These centres offer a broad range of services, including treating minor injuries, conducting diagnostic tests, providing preventive care, and handling routine illnesses. Despite this growth, urgent care facilities face unique challenges when it comes to medical billing and coding.
Common Urgent Care CPT Codes
| CPT Code | Description |
| 99202-99205 | New patient office or other outpatient visits (based on complexity) |
| 99211-99215 | Established patient office or outpatient visits |
| 99051 | Services provided in an urgent care facility during evening, weekend, or holiday hours |
| 99050 | Services provided outside of regular office hours |
| 99281-99285 | Emergency department visits (for urgent care centers operating within hospitals) |
| 99441-99443 | Telephone evaluation and management services |
| 99421-99423 | Online digital evaluation and management services |
| 94640 | Nebulizer treatment for acute respiratory conditions |
| 90471-90474 | Vaccine administration |
| 12001-12018 | Simple wound repair (laceration closures) |
| 96372 | Therapeutic, prophylactic, or diagnostic injection |
| 71046 | Chest X-ray, single view |
| 73630 | Foot X-ray |
| 97110 | Physical therapy for musculoskeletal conditions |
| 99072 | Additional supplies and staff time due to public health emergencies (e.g., COVID-19) |
Urgent Care Billing Modifiers
| Modifier | Description |
| 25 | Significant, separately identifiable E/M service |
| 57 | Decision for surgery |
| 59 | Distinct procedural service |
| 95 | Telemedicine service (synchronous) |
| 26 | Professional component |
| 50 | Bilateral procedure |
Key Steps in the Urgent Care Revenue Cycle
A well-defined revenue cycle consists of multiple stages, each playing a critical role in ensuring financial efficiency and minimizing revenue loss:
1. Patient Registration: The revenue cycle begins when a patient seeks medical services. Accurate collection of patient details, including demographics and insurance information, is crucial to avoid billing errors.
2. Charge Capture: After the patient receives treatment, all services provided are documented and captured in a secure database. Errors in charge capture can lead to lost revenue and claim rejections.
3. Medical Coding: Billable procedures and diagnoses are categorized using CPT, ICD-10, and HCPCS codes to ensure accurate claim processing. Proper coding is essential for compliance and maximum reimbursement.
4. Claim Submission: Claims are submitted electronically to insurance companies for reimbursement. Incomplete or incorrect claims can result in delays or denials.
5. Claim Adjudication: Insurance companies process and review submitted claims, determining coverage and reimbursement amounts. If issues arise, claims may be denied or require additional documentation.
6. Payment Posting: Once a claim is approved, payments are posted to patient accounts. Any payment discrepancies must be addressed promptly.
7. Denial Management: Denied claims are reviewed, corrected, and resubmitted to prevent revenue loss.Tracking common denial reasons helps reduce future claim rejections.
Best Practices for Effective RCM in Urgent Care
To maximize revenue and minimize claim rejections, urgent care facilities must implement the following best practices:
- Verify Patient Identity & Insurance Coverage: Confirm patient details, insurance ID, and coverage before providing services.
- Utilize Real-Time Medicare Eligibility Checks: Prevent delays by ensuring accurate insurance verification.
- Electronic Health Record (EHR) Systems: Use EHR software to streamline documentation and billing.
- Identify & Resolve Claim Denials Promptly: Track common denial reasons and implement corrective actions.
- Ensure Accurate Medical Coding & Compliance: Use the latest ICD-10, CPT, and HCPCS codes for proper billing and reimbursement.
- Implement Automated Billing & Payment Solutions: Reduce manual errors and accelerate the claim submission process.
The Challenges of Urgent Care Billing and Coding
Urgent care billing can be complicated, given the variety of services provided and the complex payer mix. Some of the challenges include:
1. Wide Range of Services
Urgent care centres offer an extensive array of services, from routine check-ups to more complex procedures such as X-rays and lab tests. Each of these services requires different coding, and using the wrong code can lead to denials or delayed reimbursements. Current Procedural Terminology (CPT) codes, Healthcare Common Procedure Coding System (HCPCS) codes, and International Classification of Diseases (ICD-10) codes are just a few of the essential coding systems that urgent care centres must manage accurately.
2. Complex Insurance Payer Mix
Urgent care centres typically deal with a mix of insurance providers, including private payers, Medicaid, and Medicare. Each payer has different billing requirements, which means that urgent care centres must be prepared to handle multiple billing procedures, claim types, and reimbursement processes. Understanding payer-specific rules and policies is crucial for maximizing reimbursements and avoiding denials.
3. Medical Coding for Minor and Complex Procedures
Urgent care centres are known for treating a wide spectrum of medical conditions, including simple ailments like flu or cold to more severe conditions like fractures or minor lacerations. The use of E&M (Evaluation and Management) codes and modifiers is necessary to reflect the level of service provided. Incorrect application of modifiers or codes can significantly affect reimbursement.
4. Timely Billing and Claim Submissions
Urgent care centres often see a high volume of patients each day. This means the billing and coding process must be executed efficiently to ensure timely submission of claims. The longer a claim sits unprocessed, the higher the likelihood of delay, and in some cases, the claim may be denied outright due to time limits imposed by payers. Studies show that urgent care centres that employ urgent care billing services that claim submission and follow-up can reduce claim denials by up to 20-25%.
5. Compliance with Government Regulations
As urgent care centres interact with Medicare and Medicaid, they must stay up to date with government regulations to avoid penalties and ensure compliance. The Centers for Medicare & Medicaid Services (CMS) have specific guidelines for billing urgent care services. Non-compliance can result in audits and financial repercussions, making it essential for urgent care providers to ensure that their billing processes are up-to-date and in line with current regulatory standards.
How Urgent Care Billing Services Can Help
With so many complexities involved in urgent care billing, partnering with specialized urgent care billing services providers can bring significant benefits to your practice. Here’s how these services can help your urgent care centre improve revenue cycle management:
1. Accurate Medical Coding
Professional billing services employ certified coders who have a deep understanding of the various medical codes needed for urgent care services. These experts are proficient in the latest ICD-10, CPT, and HCPCS codes, ensuring that each service rendered is billed correctly. This reduces the likelihood of errors that could lead to claim denials or underpayments, ultimately improving revenue.
2. Faster Claims Submission
By outsourcing your billing to a specialized service, you can streamline your claim submission process. The billing team ensures that claims are submitted as quickly as possible, reducing delays and speeding up the reimbursement process. Faster claims submission directly contributes to improved cash flow for the urgent care centre.
3. Efficient Denial Management
Denial management is a crucial aspect of urgent care billing. When claims are denied, it is essential to follow up quickly to resolve any issues. Urgent care billing services have experienced teams that are trained to handle denials efficiently. They know the best strategies for appealing denied claims, and they stay in constant communication with insurance companies to ensure that the claim is resolved and the reimbursement is processed.
4. Increased Revenue and Maximized Reimbursement
By accurately coding and billing for services, billing services help urgent care centres maximize reimbursement. Many urgent care centres fail to take full advantage of modifier applications, which are essential to getting the maximum reimbursement for procedures. Billing professionals are trained to apply modifiers correctly, ensuring that every service is reimbursed at the appropriate rate.
5. Ensuring Compliance
Billing services keep up with all regulations and payer-specific rules, ensuring that your urgent care centre remains compliant with both private and government payers. Compliance is essential in avoiding audits, penalties, and payment delays. With billing professionals handling your claims, you can be assured that your practice adheres to the most current healthcare standards and payer policies.
When you outsource a professional medical billing company, it ensures compliance with the payer’s specific regulations. Staying compliance with the payers, whether it is government or private, is essential for the urgent care provider.
6. Cost Savings
Hiring an in-house billing staff can be very costly, especially for the smaller urgent care providers. Outsourcing billing services practices can reduce overhead costs while improving the efficiency of their revenue cycle.
7. Focus on Patient Care
With a third-party billing service handling the complexities of coding, claim submission and follow-ups, urgent care providers can focus on their primary goal. Providers can solely focus on providing high-quality, timely care to their patients. This builds trust between the patient and urgent care providers.
Expand Your Revenue with Outsourced Urgent Care Billing Services
Partnering with Right Medical Billing for your urgent care billing services means faster claim approvals, improved cash flow, and fewer denials. Here’s what you gain:
- 99.9% Billing Accuracy: Eliminate costly errors and reduce claim rejections.
- Up to 98% Total Collections: Maximize reimbursements and minimize revenue loss.
- Faster Revenue Cycle: Enjoy a smoother, more predictable cash flow.
- Drastically Reduced Denials: Say goodbye to frustrating delays in payments.
- 100% Error-Free Patient Data Entry: Ensure accurate records and 30% fewer A/R days.
- Transparent Pricing & Procedures: No hidden fees, just clear and fair billing.
- Complete Data Security: Your practice and patient information stay protected.
- No Unauthorized Write-Offs or Adjustments: Every modification requires prior approval.
- Personalized Service & Support: Get expert assistance tailored to your practice’s needs.
Final Thought
Urgent care facilities play a crucial role in the healthcare industry, providing accessible and timely medical services to patients. However, the financial health of these centres depends significantly on the efficiency and accuracy of their billing and coding processes. Given the complexities involved, ensuring compliance, reducing claim denials, and maximizing reimbursements require expertise that most in-house teams may struggle to provide. By leveraging professional urgent care billing services, providers can enhance operational efficiency, reduce administrative burdens, and focus on delivering high-quality patient care.
Partner with CloudRCM for efficient Urgent Care Billing Services
If you’re looking for a reliable and experienced medical billing partner, CloudRCM is here to help. Our team of certified billing professionals specializes in urgent care billing services, ensuring maximum reimbursements, faster claims processing, and compliance with the latest regulations. With our 99% claim accuracy rate, efficient denial management, and data-driven approach, we optimize your revenue cycle and eliminate unnecessary financial stress.
Contact CloudRCM today at (224) 231-6880 to improve your urgent care billing and coding and take your
FAQs
What is the importance of accurate documentation in urgent care billing?
Accurate documentation ensures the correct E/M code selection, supports medical necessity, and reduces claim denials.
How can I improve the accuracy of my urgent care billing?
Strategies include regular staff training, utilizing advanced billing software, and conducting regular audits to identify and address errors.
What are the main considerations when selecting an E/M code for an urgent care visit?
Considerations include the level of medical decision-making, patient history, physical exam complexity, and time spent with the patient.
What is the “place of service” code for urgent care?
The standard place of service code for urgent care is “20.”
How do modifiers impact urgent care billing?
Modifiers help clarify services, such as modifier “25” for a significant E/M service performed with a procedure.
What are the potential challenges in urgent care billing?
Challenges include handling a variety of services, dealing with complex payer requirements, and ensuring accurate coding for both simple and complex procedures.
