Monica Klosa

Chief Operating Officer,
PV Billing

Urgent Care Billing

PV Billing understands the full scope of urgent care billing. Our team features experts in each and every one of urgent care billing’s 7 C’s of:

1. Contract negotiations: PV Billing has staff completely versed in what the payors are actually expecting in urgent care negotiations? Kelly Mattingly, Director of Contracting and Credentialing for PV Billing says, “It tends to go smoother each time we call the same provider representative for a particular payor. We know (and they know we know) what possible contract terms are available.” Our relationships, experience and knowledge can pay off in speeding up the process and getting the best possible rates for your center.
2. Credentialing: Some payors require each provider to be individually credentialed with the payor. To speed up this process, you need an expert to fill out this complex paperwork; and you need it filled out correctly the first time, every time. Why? The process often takes almost six months (180 days is the NCQA standard), but even one small mistake and the payor can request more information and the 180-day deadline is reset. The physician may be out of plan for many additional months.
3. Coding: Every data entry specialist at PV Billing is a Certified Professional Coder (CPC). Why is this important? Coding is critical, because every dollar that you receive is attached to a code (and sometimes a modifier). Your urgent care center may be unknowingly miss out on hundreds-of-thousands of dollars. Virtually every urgent care center we have taken on board has been able to capture an additional 10-20% of revenue simply by coding correctly.
4. Compliance: If you are using the wrong codes or the wrong modifiers, not only might your center be missing out on a major source of revenue. Your urgent care may, also, find itself in an audit nightmare and a compliance disaster. We have seen urgent care centers fail audits and spend hundreds-of-thousands of dollars to defend themselves against subsequent legal action. In addition to our coding specialists, the Practice Velocity software that we use offers an automated layer of audit protection. Practice Velocity software gives an automatic audit trail for every evaluation and management (E/M) code on every chart. Many audits of Practice Velocity charts simply involve an auditor looking at 10-20 charts, and the audit is done. In addition, many auditors have raved to the clinic about this “wonderful” and “simple” system.
5. Claim submission: We submit claims electronically for Medicare, Humana, United Healthcare, Medicaid, Workers Compensation, Employee-Paid Services, and many other payors and visit types.
6. Claim formatting: Invoice even one incorrect digit, code or field on a billed claim, and the entire claim may fail. PV Billing employs specialists who understand how to avoid these denials. When denials do happen, our billers know how to fix the formatting rapidly and submit the claim on a timely basis.
7. Collections: When portions of claims are turned over to patient responsibility, PV Billing will rapidly submit clearly-formatted statements to the patients. Our new functionality allows client to automate credit card billing even months after the patient visit? This means that instead of a typical payment rate of 50%, many urgent care centers should see payments on portions of claims deemed patient responsibility increase to 90%+. That makes a major difference in your collections. In addition, the PV Billing team systematically bird dogs delinquent accounts? Claims are turned over to a collection agency on a timely basis.

Call PV Billing today to receive more information.