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Plutus Health Specialties

Urgent Care Billing

Urgent care clinics acts as a gap between primary care provider and the emergency room.

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Urgent care clinics acts as a gap between primary care provider and the emergency room.

Urgent care clinics acts as a gap between primary care provider and the emergency room. They generally do not have a pre-registration process, due to the walk-in nature of appointments similar to ED, The major difference from the ED to Urgent care facilities is they treat only patients with relatively minor complaints and also they use the POS 20 (majority) or POS 11(Minorly) for their claims based on service performed in Facility or office.

We at Plutus Health, bill the services rendered at Urgent cares centers using appropriate S codes ( S9088, S9083) with the E/M Level codes like 99213,99214 and 99204 to get a higher reimbursement with zero risk of billing and coding errors. We also ensure the practice remains in compliance with regulatory agencies, like the Office of the Inspector General and CMS.

The Major Procedure performed in Urgent care facility are Sutures, Cast and Splints, BP check, Flu shot and Urinalysis. Our Urgent care clients handle patient conditions that are similar to a primary care physician’s office. However when it comes to Urgent care billing Plutus Health Urgent care coders and billers have the skills to recognize that there are urgent care-specific “S” codes that are usually different in usage that codes used in a primary care setting.

Plutus Health’s Urgent Care billing team leverages multiple options when coding and billing for urgent care services rendered:

  • S9088 “treatment in an urgent care center ” allows for Plutus Health to bill for its Urgent cares clients for the evaluation and treatment of various medical conditions in an urgent care setting that is more expensive than a primary care setting. Plutus Health’s coding team will ensure that the S9088 code does not stand alone and is billed with an appropriate evaluation and management (E/M) code. The S9088 code allows the Plutus Health Billing team to ensue our urgent care clients get reimbursed at least a portion of the increased cost of providing immediate care.
  • Plutus Health also has experience in the use of CPT code – S9083 – that enables our urgent care clients to charge a global fee for service, regardless of what treatment the patient receives.
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The Plutus Health Urgent care coding team are experts applying AMA guidelines in reviewing medical records to determine if the appropriate code is 99214 for an “office visit for the E&M of an established patient, which typically requires at least two of these three key components: a detailed history, a detailed examination and medical decision making of moderate complexity.”

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Plutus health urgent care coders also review level of complexity to determine use of codes such as 99213 vs 99214 to ensure compliance and accurate reimbursement. Finally our coders also leverage codes such as 99204 for new patients of our urgent care clients as long criteria’s such as a comprehensive history, comprehensive exam, and medical decision-making of moderate complexity are met and thereby ensuring compliance and revenue.

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