Wiki Billing information for urgent care

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jennburgel

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Hi,

Can anyone assis me in information regarding the billing process for an Urgent Care. I have recently been asked to help with their billing co nightmare. My expertise is in an ASC. Anything you can post is helpful. It looks like they some contracts are professional pos 11 and some are pos 20.
 
My understanding you need to be a free standing urgent care center and only provide services on a walk in basis. I've always run into this problem at a payer. My previous company in New England very few claims were billed as place of service. It always caused problems as POS 11 out of network would typically deny when 20 always pays as Urgent care. The current payer I work with if the claims is manually processed and its seen as Urgent Care in the payee name on POS 11 we pay it.
 
Hello
The procedures and place of service that you use on your claims are based on how the Urgent Care was credentialed. The clinic might not have qualified as an urgent care so you would only be able to use POS 11. Some payers only allow urgent care centers to bill globally without carve-outs and then you would use POS 20 with the S9083 procedure code. Good luck!
 
Urgent care reimbursement

Thank you Coding King,

We are a freestanding urgent care walk in only 12 hours. Some claims pay as the S code and some pay as office visit coding ie: medicare. Can you tell me is a pt has Medicare Primary and Horizon NJ Helath ( Medicacid ) secondary and you submitt to the secondary with the office visits and you are contracted as a pos 20 will the medicaid still pay the 20% co ins from mcr. I am under the impression that they should drop the claim to the secondary with the S code and the Pri EOB and thena they will pick up the 20% because the3 secondary is contracted with the pos 20. Am I correct? They have an entire mess that they are trying to re coup and the billing co just keep resubmitting without making any changes.
 
What happens if we must bill the primary payor using the 'S' global code and the claim then crosses over to Medicare or another payor who does not recognize the 'S' codes?
What will the secondary payor due? Will they pay anything? How would payment be calculated?
 
jennburgel said:
Urgent care reimbursement

Thank you Coding King,

We are a freestanding urgent care walk in only 12 hours. Some claims pay as the S code and some pay as office visit coding ie: medicare. Can you tell me is a pt has Medicare Primary and Horizon NJ Helath ( Medicacid ) secondary and you submitt to the secondary with the office visits and you are contracted as a pos 20 will the medicaid still pay the 20% co ins from mcr. I am under the impression that they should drop the claim to the secondary with the S code and the Pri EOB and thena they will pick up the 20% because the3 secondary is contracted with the pos 20. Am I correct? They have an entire mess that they are trying to re coup and the billing co just keep resubmitting without making any changes.
Click to expand...
What happens if we must bill the primary payor using the 'S' global code and the claim then crosses over to Medicare or another payor who does not recognize the 'S' codes?
What will the secondary payor do? Will they pay anything? How would payment be calculated?
 
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