Urgent Care Billing Services
When your door is open long hours and patients walk in expecting fast care, billing shouldn’t slow you down. High visit numbers, a mix of low- and high-acuity services, point-of-care testing, worker's comp and auto injury cases, and always changing payer regulations make urgent care clinics have a particular billing scene. At Sirius Solutions Global, we remove the billing burden from your staff so you may provide quick, compassionate care and get compensated for every service you provide.
Our Urgent Care Billing Services
Sirius Solutions Global offers an end-to-end urgent care RCM solution designed for the fast pace of your clinic:
Eligibility & benefits checks (upfront)
Real-time verification before the visit reduces surprise denials and helps staff collect co-pays and known patient responsibility amounts up front.
Rapid charge capture & coding
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Timely, accurate charge entry for E/M visits (walk-in and telehealth), procedures, X-rays, and POCT.
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Correct CPT/HCPCS/ICD-10 mapping for minor procedures, splints, laceration repair, fracture management, and immunizations.
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Proper modifier application (RT/LT, 59/XC/XU) to protect reimbursement.
Point-of-care testing & lab reconciliation
We ensure POCT codes and supply charges are captured and reconciled with EHR entries and inventory, so no test goes unbilled.
Claims submission & payer edits
Clean claim scrubbing that applies payer-specific edits before submission to increase first-pass acceptance rates and shorten days-in-A/R.
Denial management & appeals
Rapid denial triage and root-cause correction. We resubmit corrected claims, file appeals with supporting documentation, and identify systemic fixes to prevent repeat denials.
Workers’ comp / auto-injury billing
Specialized workflows to manage adjuster communications, required forms, correct fee schedules, and timely filings all tailored by state requirements.
Patient statements & collections
Patient-friendly bills, multiple payment options, and soft collections that keep patient relationships intact while improving recovery.
Reporting & KPIs
Actionable dashboards for: visit volumes, first-pass acceptance, denial reasons, AR aging, top deniers, and revenue per visit — updated regularly so you can act fast.
The benefits of outsourcing urgent care billing to us
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More time for clinicians and front desk staff — less billing rework and fewer payment calls.
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Faster payments — cleaner claims and quicker appeal resolution.
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Reduced denials — systematic prevention and targeted appeals.
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Predictable revenue — better collections, fewer write-offs.
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Actionable insight — reporting that tells you which payers, CPTs, or clinics are underperforming.
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Scalable support — from single-site clinics to multi-location urgent care networks.
Why urgent care billing needs a specialist
Urgent care clinics run fast. Walk-ins, point-of-care tests, variable payer rules, workers’ comp cases and telehealth add complexity. Small front-desk mistakes or a missed modifier can turn a perfectly good visit into a denied claim and that’s lost revenue you can’t get back. That’s why urgent care billing should be handled with specialist workflows, repeatable SOPs, and real-time controls that catch errors before claims go out.
Unique challenges include:
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High visit throughput — you need quick, accurate charge capture and near-instant eligibility checks.
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Mixed service mix — E/M visits, minor procedures, X-rays, lab and POCT (point-of-care testing), immunizations, and DME all in the same encounter.
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Workers’ comp, auto, and liability cases — different rules, forms, and timelines.
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Frequent payor variability — some insurers pay for rapid tests differently, others limit visit frequencies.
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Time pressure — front desk and clinicians cannot spend extra minutes on billing paperwork.
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Telehealth and hybrid visits — policies shifting post-pandemic require tight operational controls.
If any of these are handled poorly, revenue leaks. We fix that by tailoring workflows to the urgent care rhythm.
How Sirius Voice AI protects revenue
Streamline your financial operations
More than a Voice,
Your Companion
Focused on Improving Financial Operations of Your Practice
Sirius doesn’t replace people it amplifies them. Think of the AI caller as a super-efficient paralegal + receptionist that can:
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do eligibility calls and log proof,
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confirm or cancel appointments with empathy,
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call payers for simple status checks,
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and capture structured patient responses.
Every automated action is visible to your staff in a single dashboard: call transcripts, suggested claim fixes, and a triage flag that tells a human what to review next. This hybrid approach prevents errors while letting your team focus on the exceptions that need judgment. Vendors in this space report meaningful operational gains from automating routine calls and scheduling tasks.
Revenue-protecting actions you can add today
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Real-Time Eligibility & Front-Desk Handoff
Verify coverage before or a check-in and flag high-risk visits (self-pay, out-of-network, workers’ comp). When eligibility fails, Sirius logs the reason and prompts a human-friendly script for staff to collect payment or financial consent. Verifying eligibility every visit is a top urgent-care best practice. -
POCT (Point-of-Care Test) Capture & Reconciliation
Ensure rapid tests, labs, and supplies are itemized with correct CPT/HCPCS codes and linked to the visit. Sirius can remind staff to attach test results and then surface missing items to a human reviewer before claim submission. -
Smart Charge Capture with Human Audit
Using rule-based checks (and comparing to historical visit patterns), Sirius flags suspect coding for manual review preventing both underbilling and risky upcoding. -
Automated Payer Follow-Up Queue
Claims that stall are automatically placed into a priority queue with suggested action steps (appeal, resubmit, gather medical records). Humans own the high-value exceptions; AI handles status polling and routine re-submissions. -
Patient-Friendly Balance Calls & Payments
Siri-like, human-sounding calls or SMS gently remind patients of balances and provide payment links; difficult conversations are escalated to billing staff with a full transcript and suggested next steps. -
Seasonal Surge Mode
During flu season or local outbreaks, Sirius scales outreach for pre-visit prep, drive-through testing logistics, and post-visit check-ins — with human supervisors on shift to handle spikes.
Real-world scenarios we handle every day
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Lacerations & minor surgical repairs — correct CPT selection, anesthesia codes, supply charges and appropriate documentation to support complexity.
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Fracture care — splint/cast application codes, X-ray interpretation, and follow-up visit coding.
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Respiratory visits — POCT influenza, strep, COVID tests, rapid antigen vs. PCR billing and appropriate lab path routing.
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Immunizations — product and administration codes, combo vaccines, and tracking multi-dose series.
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UTIs and ear infections — E/M level capture and correct diagnosis linkage.
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Telehealth & virtual triage — proper coding for tele-visits, audio-only encounters, and e-visits where applicable.
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Occupational injury & pre-employment physicals — customized workflows and billing for employer-paid services.
Each of these requires a slightly different documentation approach and coding nuance - we make sure those nuances don’t cost you money.
Common revenue leaks we find in urgent care clinics
Before we onboard a client we do a quick audit here are the typical leaks we see:
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Missed charge capture for point-of-care testing or supplies.
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Improper use of modifiers for bilateral procedures, anesthesia, or supplies.
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Downcoding of E/M visits because documentation wasn’t mapped to the right CPT level.
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Unbilled or underbilled laceration repairs and fracture care procedures.
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Confusion around reporting and billing for telehealth or telephone encounters.
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Poor management of worker’s comp and auto-injury authorizations leading to delayed or denied payments.
We stop those leaks by tightening the intake, documentation, and claims processes.
AI & technology practical tools used with human judgment
We use automation thoughtfully to speed routine tasks and let experienced staff concentrate on judgment work:
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Pre-submission scrubbing checks for missing modifiers, mismatched diagnoses, and unit errors.
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Denial prediction spots claims at high risk of denial so we can fix them before submission.
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Smart reconciliation automatches ERAs/EOBs and flags underpayments automatically.
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Telehealth policy tracker keeps up with payer changes so your tele-encounters are billed correctly.
Technology saves time; it doesn’t replace the clinical and coding expertise required for urgent care claims.
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