The terms contracting and credentialing are often used interchangeably, but the processes involved in each, while interdependent, are very different and have different outcomes. Contracting, in brief, is the process of creating a formal legal agreement between the payer (insurance company) and the provider (facility, physician, and/or physician extender). The contract outlines expectations and requirements of all parties. The effective date of the agreement, the reimbursement/fee schedule, place of service, termination clauses, services allowed and …
Read MoreUpdated: Experity Issues Guidance on Optimal Coding for Services Related to COVID-19
COVID-19 has been officially declared a pandemic, and school districts, sporting events, and cultural traditions like St. Patrick’s Day parades are being canceled in order to lower the risk of transmission among large throngs of people. One thing that goes on, however, is the day-to-day operation of the urgent care center—the only difference being that your work is more essential than ever. Secondary to that, of course, is the need to be properly reimbursed for …
Read MoreTaking Pictures, Dog Paddling, and Apple Picking: A Metaphorical Approach to Healthy Revenue Cycle Management Metrics
You have seen all the articles about benchmarking and standard revenue cycle management metrics. The repetition of these basic articles is nauseating. This is not one of those articles. To illustrate that, let’s start by asking, what do photography, dog paddling, and apple picking have to do with your urgent care billing? Photography Standard RCM metrics are like the settings on your digital camera. Most people set the camera to Program mode (or “P” for …
Read MoreRinging in 2020 with CPT Changes
It’s that time of year again. The American Medical Association has implemented the 2020 Current Procedural Terminology (CPT) code set. This year we have 394 changes: 248 additions, 71 deletions, and 75 revisions. All changes took effect on January 1. While the impact to urgent care is minor, several items bear highlighting Health Behavior Assessment and Intervention The codes in the Health Behavior Assessment and Intervention section are used to report services provided to improve …
Read MoreAlready Looking Forward to 2021—and (Hopefully) Smoother Sailing with E/M Coding
On November 1, 2019, the Centers for Medicare & Medicaid Services (CMS) confirmed with the final rule for 2020 that they have accepted all of the American Medical Associations (AMA) recommendations for coding of office and outpatient evaluation and management (E/M) services starting in 2021. This will offer some documentation relief for providers who have been held to dated 1995 and 1997 guidelines that were written before the use of electronic medical records. However, these …
Read MoreThree Tips to Optimizing Patient Collections
Over the last decade, perhaps the most staggering shift in consumer-based healthcare has been the increase in patient responsibility. Due to the rise in high-deductible health plans (HDHPs), providers are now faced with the challenge of collecting an average of 35% of their revenue from patients, without a downward swing in the insured population. Consider the following: In 2018, 85% of covered workers had a deductible, up from 59% in 2008. The average deductible in …
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