Practice Management
Phyllis Dobberstein, CPC, CPMA, CPCO, CEMC, CCC One of the biggest challenges for an urgent care is billing insurance as a non-participating provider. When opening a new practice or adding a clinic, completed credentialing and contracting is essential and has a direct impact on the overall success for a new business. Opening without effective dates may result in cash flow shortages due to the fact that most health plans will not offer retroactive effective dates. Additionally, …
Read MorePhyllis Dobberstein, CPC, CPMA, CPCO, CEMC, CCC, is RCM Compliance Manager, Experity With the fall season comes all the coding changes for the year. This starts with the 2024 edition of the ICD-10-CM codes, which went into effect on October 1, 2023. As a reminder, there is no grace period. Changes are effective on dates of service as of October 1. Prior to this date, practices should continue to use the 2023 ICD-10-CM code set. This …
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Heather Real Click Here to download the article PDF In the journey of an urgent care visit, where does the patient story begin? Is it when the patient walks through the door, or did it start when the patient was still at home Googling “urgent care near me” on their phone? It is likely neither of these. The patient journey to your urgent care actually begins before they even have a sniffle, fever, or injury; …
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Phyllis Dobberstein, CPC, CPMA, CPCO, CEMC, CCC Modifier 25 is used to indicate a significant, separately identifiable evaluation and management (E/M) service was required on the day of a minor surgical procedure. The procedure performed must have a global period of 0 or 10 days. An example of this is a laceration repair. Modifier 25 is overused in the industry and has been under scrutiny from payers for decades. Now private payers are implementing policies …
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Click Here to download the article PDF Urgent message: When considering growth in urgent care, there are both advantages and challenges to acquiring an existing urgent care center vs developing a completely new business. Heather Real The urgent care industry is ever-evolving and flexing to meet the needs of patients and communities. This means the way operators enter the industry needs to be flexible, too. While starting a new business in a freshly outfitted space …
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Click Here to the download PDF. With expiration of the national Public Health Emergency (PHE) as of May 11, the revenue cycle management (RCM) industry has to adjust to the “new normal.” Some emergency declarations were tied to the end of the PHE and others are not. While not a comprehensive list, I’ve outlined some of the most urgent care-relevant changes below. Payers Coverage for COVID-19 Testing, Treatments, and Vaccines During the PHE, federally regulated …
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Denials and rejections are inevitable in medical billing and can have drastic repercussions on the overall profit of an urgent care practice. Studies show almost 30% of medical bills are prone to errors. Avoid these common mistakes to improve the return on your investment. Eligibility Errors Avoidable eligibility errors are the biggest issue in urgent care billing. Over one-third of total visits with a rejection or denial are due to a lack of proper registration …
Read MoreHeather Real With today’s urgent care operators challenged with increasing expenses and stagnant reimbursements, many thoughtful entrepreneurs turn to ancillary services to drive more revenue into their business. These offerings are numerous and varying in nature. When determining if and what to add to an urgent care business, you’ll need to ask some crucial questions: As the competition for patient loyalty heats up, many operators are looking for ways to stand out. Some ways of …
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Monte Sandler Insurance plans are scrutinizing claims more than ever before. Common questions from our clients are: What does this mean? What should I do? Should I be worried? Generally, there are three types of payer reviews: prepayment, postpayment, and probe. The first step is to figure out what type of review it is. What you do and how you handle the review is dependent on that information. Should you be concerned? Always. Payer reviews …
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Heather Real There are many reasons to start your own urgent care, whether it be feeding your entrepreneurial spirit, investing in an industry that has proven to be stable and growing (even amidst multiple economic crises in the last three decades), or responding to the needs of a community. For many, the reasons include at least some of these, and more. Realizing the desire to take on this project is the first step; however, there …
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