Top 5 Questions to Ask When Vetting a Medical Billing Company for Your Urgent Care

‍

Outsourcing medical billing is a strategic decision — not just an administrative one. The right revenue cycle management (RCM) partner protects your cash flow, improves compliance, reduces denials, and strengthens long-term profitability.

Urgent care centers operate differently than primary care or specialty clinics. High visit volume, walk-in variability, occupational medicine contracts, and E&M distribution all require billing expertise that is both specialized and proactive.

Before signing an agreement, ask these five critical questions.

‍

1. Do You Specialize in Urgent Care Billing?

Not all billing companies understand urgent care dynamics.

Urgent care requires expertise in:

• High-volume E&M coding (99203, 99204, 99213, 99214)
• Modifier usage (25, 59, XU)
• In-house labs and CLIA-waived testing
• Occupational medicine billing
• Payer-specific urgent care policies
• Real-time eligibility verification (RTE)

Ask:

• How many urgent care clients do you currently serve?
• What is your average days in A/R for urgent care specifically?
• What is your clean claim rate for urgent care clients?

A billing partner unfamiliar with urgent care workflows will create denials that compound quickly.

‍

2. What Are Your Denial Rates — and How Do You Manage Them?

Denials are not just numbers — they represent delayed cash and operational drag.

Strong RCM companies should provide:

• First-pass resolution rate
• Denial rate by payer
• Appeal turnaround time
• Root-cause reporting

Ask:

• Do you track denial categories by CPT and payer?
• How do you address downcoding trends?
• What percentage of denied claims are successfully overturned?
• What automation or AI tools do you use to proactively prevent claim rejections or denials?

A strategic partner doesn’t just “work the denial” — they analyze trends and implement preventive corrections.

‍

3. How Transparent Is Your Reporting?

Transparency is non-negotiable.

Your billing partner should provide real-time access to:

• A/R aging by bucket (0–30, 31–60, 61–90, 90+)
• Net collection rate
• Gross collection rate
• Adjustments by payer
• Patient balance aging
• CPT utilization trends

Ask:

• Will we have direct reporting access?
• How often are performance reviews conducted?
• Do you provide monthly KPI summaries?

If reporting is vague, delayed, or aggregated without detail, that is a red flag.

‍

4. How Do You Handle Compliance and HIPAA Risk?

Revenue cycle management is a compliance-sensitive function. Your billing company must demonstrate strong safeguards.

Ask:

• Will you execute a Business Associate Agreement (BAA)?
• How is PHI protected?
• What are your audit protocols?
• How do you stay current on CMS and payer updates?

A billing partner should operate with disciplined processes — not reactive troubleshooting.

‍

5. How Do You Align With Our Growth Strategy?

The right medical billing company does more than submit claims.

They should support:

• New location credentialing
• Payer enrollment expansion
• Occupational medicine program setup
• Coding optimization reviews
• Fee schedule analysis
• E&M distribution benchmarking

Ask:

• How do you support multi-site urgent care growth?
• What onboarding process do you follow?
• Do you conduct quarterly strategy reviews?

A forward-looking RCM partner acts as a financial steward — not just a back-office processor.

‍

Final Thoughts

Urgent care operates at speed. Your billing partner must match that pace.

When properly aligned, a specialized medical billing company can:

• Reduce days in A/R
• Improve clean claim rates
• Increase net collections
• Strengthen compliance posture
• Deliver actionable revenue insights

The difference between average and high-performing urgent care organizations often comes down to disciplined revenue cycle oversight.

Before signing your next agreement, ask better questions. If you’d like to learn more about urgent care billing best practices or how the right billing platform can help maximize your revenue, contact sales@urgentiq.com