What is the best way to get my practitioners credentialed with various insurance companies and networks? It is frustrating to try and navigate this convoluted process. I am asked by each insurance company to complete a mound of paperwork and collect a stack of supporting documents for each practitioner. Then I wait months for approval notifications and effective dates. As a result, we end up losing some patients because they want to be treated at …
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2018 Current Procedural Terminology (CPT) Code Changes
There are 314 code changes in the CPT manual for 2018, with 172 new codes, 60 revised codes, and 82 deleted codes. Most of the changes affect surgery procedures, but the updates include several changes that are relevant to urgent care. For your convenience, we have listed these changes in expected relevance to urgent care: Radiology Codes for x-rays of the chest and abdomen have been deleted and replaced with codes based on the number …
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Be Mindful of Dates of Service When Coding for Flu Shots—or Get Claims Denied
Among the Centers for Medicare and Medicaid Services’ new codes is one that’s likely to be confusing as patients start coming in for flu shots. A quadrivalent vaccine made and distributed by Sequirus is available for reporting, but if billing staff use the corresponding code, 90756 (Influenza virus vaccine, quadrivalent [ccIIV4], derived from cell cultures, subunit, antibiotic free, 0.5mL dosage, for intramuscular use) before January 1, 2018, the claim will be denied. Instead, they’re advised …
Read MoreWhen Billing by Exam Type, the Revenue Is in the Details
Q: What is the difference between a detailed exam and an expanded problem-focused exam? A: Unfortunately, there is no straightforward answer to that question. The Centers for Medicare and Medicaid Services (CMS) provides some guidance in the 1995 and 1997 guidelines (https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/MLN-Publications-Items/CMS1243514.html). The 1995 guidelines state the documentation of the examination as follows: Problem-Focused – A limited examination of the affected body area or organ system. Expanded Problem-Focused –A limited examination of the affected body …
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Helping Workers Take Ownership by Giving Them Ownership
Many urgent care operators work hard to get their employees to take ownership of their jobs. Now one of the key stakeholders in the growth of the urgent care industry has taken those efforts to the next level by literally making employees partial owners of the company they work for. Practice Velocity CEO David Stern, MD surprised employees at a recent town hall-style meeting by telling them how much he appreciates the positivity they bring …
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Understand the Rules—and Code Correctly—When Charging a Facility Fee
Whether an urgent care can bill Place of Service -19 or -22 requires an understanding of the criteria enabling facility code sets. An urgent care joint venture between physicians and a hospital recently inquired about using Place of Service 22 (Outpatient Hospital), enabling facility fees. The key with billing the urgent care as “outpatient hospital” is that it must truly qualify for that service. I have reservations as to whether the urgent care could bill …
Read MoreImaging: X-Rays and Computed Tomography
Q. I understand that there will be reductions for x-ray reimbursements from Medicare in 2017. Is this true? A. To give imaging providers an additional incentive to adopt more advanced x-ray technology, Medicare will reduce reimbursement, beginning in 2017, for the technical component (and the technical component of the global fee) in claims submitted for x-rays performed with analog equipment. The cuts will continue in future years for those using computed radiography equipment (Table 1). …
Read MoreHow to Talk About Billing Codes to Providers Who Don’t Know Them
Q. How do I talk to my providers about the documentation to support specific International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes when most of them do not really know the codes, but they know the terminology? A. Now that we are 1 year into using ICD-10-CM codes, most expect the Centers for Medicare & Medicaid Services (CMS) to lift the grace period for allowing providers to assign unspecified diagnosis codes. It is …
Read MoreICD-10-CM and ICD-10-PCS Changes Effective October 1, 2016
Because it has been 4 years since the last annual update of the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) and because 2016 is the first year for the Centers for Medicare & Medicaid Services (CMS) to make updates to ICD-10-CM, CMS made many edits to the classification’s code set. On October 1, 2016, International Classification of Diseases, 10th Revision, Procedure Coding System (ICD-10-PCS) will include 3651 new codes and 487 revisedcodes,1 and …
Read MorePlantar Warts, Digital Nerve Block in Lacerations, and Established Patients
Q. We had a patient present with 12 plantar warts. The provider used liquid nitrogen to freeze all 12 of the warts. What code should I bill for this procedure? A. In this case, you would bill Current Procedural Terminology (CPT) code 17110, “Destruction (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement) of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions.” Use only code 17110 once because the …
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