Maximize your urgent care facility revenue with high-volume billing expertise. Our specialized team handles rapid claim processing, real-time eligibility verification, and multi-location coordination to keep your cash flow strong. With over 10,000 urgent care centers nationwide generating $35+ billion in annual revenue, having specialized billing support is critical for staying competitive.
Urgent care facilities average 30-60 patients daily, generating thousands of claims monthly. Without rapid submission workflows, accounts receivable can balloon past 45 days, creating cash flow crises. Studies show delayed claim submission beyond 48 hours increases denial rates by 12%.
Over 15% of walk-in patients arrive without valid insurance cards, and 8-10% have coverage that has lapsed or changed. Without real-time eligibility verification, urgent care centers face an average $45-$65 per patient in unrecoverable charges.
When patients receive E/M services alongside X-rays, lab work, splinting, or wound care on the same visit, precise modifier application (modifier 25, 59, XE, XS) is critical. Incorrect bundling of same-day services can reduce reimbursement by 20-35% per encounter.
Urgent care E/M coding spans levels 99201-99215 for new patients and 99211-99215 for established patients, with 2021 guidelines emphasizing medical decision-making complexity. Undercoding by just one level across 40 daily visits can cost a practice $150,000+ annually.
Weekend and evening visits qualify for add-on codes 99050-99060, but only when documentation explicitly supports the after-hours designation. Approximately 40% of urgent care visits occur outside standard business hours, representing significant untapped revenue.
Occupational health claims require separate billing workflows with state-specific fee schedules, first report of injury documentation, and coordination with employers, insurance adjusters, and case managers. Workers compensation claims typically take 2-3x longer to adjudicate.
Our systems and workflows are optimized for rapid claim submission and processing to match urgent care volume.
Integrated eligibility verification ensures coverage confirmation before service delivery.
Specialized training in urgent care E/M coding ensures proper level assignment and documentation.
Our platform seamlessly handles multiple urgent care locations with centralized reporting.
Expert billing for all levels of urgent care visits with proper E/M coding and documentation support.
Specialized billing for workplace injuries, DOT physicals, drug screening, and workers compensation claims.
Comprehensive billing for in-office procedures, X-rays, lab tests, and point-of-care testing.
Centralized billing services for urgent care chains and multi-location facilities.
Common urgent care CPT codes include E/M codes 99201-99215 for new and established patient visits, after-hours add-on codes 99050-99051, procedure codes 12001 for wound repair, 29125 for splint application, 71046 for chest X-ray, 87880 for rapid strep test, and 99000 for specimen handling.
Essential urgent care ICD-10 codes include J06.9 (acute upper respiratory infection), J02.9 (acute pharyngitis), J20.9 (acute bronchitis), N39.0 (urinary tract infection), R10.9 (abdominal pain), S61.419A (hand laceration), S93.401A (ankle sprain), M54.5 (low back pain), R50.9 (fever), L03.90 (cellulitis), H10.9 (conjunctivitis), and T14.8 (other injury).
Our 5-step process: 1) Practice Assessment and Onboarding - thorough analysis of billing workflows, payer mix, and denial patterns. 2) Technology Integration - seamless connection with eClinicalWorks, Practice Fusion, Athenahealth, NextGen, and other major EHR systems. 3) Coding Optimization - certified coders review every encounter for accurate E/M level assignment and proper modifier application. 4) Claim Submission and Follow-Up - claims scrubbed, validated, and submitted within 24 hours with proactive denial management. 5) Reporting and Continuous Improvement - monthly performance dashboards and quarterly optimization reviews.
The urgent care industry represents a rapidly growing segment of the healthcare delivery system, with over 10,000 centers nationwide generating more than $35 billion in annual revenue. Urgent care sits between primary care and emergency medicine, with a unique payer mix averaging 60% commercial insurance, 10% Medicare, 15% Medicaid, and 15% self-pay. Specialized billing is critical because generic billing companies miss urgent care-specific nuances like same-day preventive and sick visit splitting, proper use of S codes for non-covered services, after-hours modifier optimization, and workers comp coordination. Modern revenue cycle management leverages AI-powered coding suggestions, automated eligibility verification, predictive denial analytics, and real-time dashboards. Compliance and audit protection remain paramount, with HIPAA compliance, CMS audit preparedness, OIG fraud prevention, and proper documentation standards all requiring expert attention.
Q: What CPT codes are most commonly used in urgent care billing? A: E/M codes 99201-99215, after-hours codes 99050-99051, wound repair codes 12001-12007, splint codes 29125-29131, and diagnostic codes 71046 and 87880. Q: How does urgent care billing differ from ER billing? A: Urgent care uses office-based E/M codes while ERs use ER-specific codes 99281-99285 with higher reimbursement but different documentation requirements. Q: What is the average reimbursement per urgent care visit? A: Average reimbursement ranges from $100-$250 depending on complexity, with additional revenue from ancillary services. Q: How can urgent care centers reduce claim denials? A: Real-time eligibility verification, accurate E/M documentation, proper modifier usage, timely claim submission, and systematic denial tracking. Q: What are after-hours billing codes? A: CPT codes 99050 and 99051 are add-on codes for services after posted hours or on evenings, weekends, and holidays. Q: How does workers compensation billing work? A: Requires separate workflows with FROI documentation, state-specific fee schedules, and coordination with adjusters. Q: What EHR systems integrate with Medtransic? A: eClinicalWorks, Practice Fusion, Athenahealth, NextGen, AdvancedMD, DrChrono, and Experity. Q: How long to see results after switching? A: Measurable improvements within 60-90 days, with full optimization in 4-6 months.
Medtransic revolutionized our billing operations across all five urgent care locations. Their high-speed processing and real-time eligibility verification improved our cash flow by 40% while reducing our denial rate to under 2%.
Contact Medtransic today for expert urgent care billing services. Call 888-777-0860 or visit https://medtransic.com/contact for a free consultation.