In the May issue of JUCM, we outlined what we were seeing with E/M coding levels utilizing the new AMA guidelines vs 2020 and 2019 levels. As COVID-19 visits steadily declined from January through June, we began to see a return to more “normal” urgent care visits. That was short-lived. July’s sharp increase in visit volumes was again driven by COVID-19! Here’s the update we promised. As a reminder, we saw E/M levels decline in …
Read MoreCredentialing: Why Should I Hire a Professional?
In the words of Red Adair, “If you think it’s expensive to hire a professional to do the job, wait until you hire an amateur.” Credentialing dictates how you bill. Do I bill as a group? Should I credential my nonphysician practitioners (NPP)? Which place of service (POS) should I bill with based on my contract? These are all important questions. Did you know that in April of this year, an urgent care chain reached …
Read MoreCan I Bill Patients for COVID-19 Vaccine Administration?
As practices start offering vaccinations for COVID-19 to their patients, we are getting a lot of questions about whether the patient can be billed for the administration. The answer is an emphatic No. The Office of the Inspector General has received complaints from patients about charges by providers when getting their COVID-19 vaccines. So, on April 15, 2021, the Principal Deputy Inspector General Christi A. Grimm issued a message regarding provider compliance with the COVID-19 …
Read MoreNew Technical Corrections Issued by the AMA Explained
On March 9, 2021, the American Medical Association updated the new evaluation and management (E/M) coding guidelines with technical corrections. These clarifications apply to the office visit codes 99202–99215 and are retroactive to January 1, 2021. In the past few months there has been industry confusion over whether a test can be counted under the data element for the E/M level when the practice is also billing for the test. The AMA has answered this …
Read MoreCredentialing and Contracting: What to Expect When Expanding
For those trying to grow their urgent care business, conversations around payer contracting and credentialing (CC) can often be overwhelming and seem contradictory to the mission of On-Demand Care. Tammy Mallow, our resident Experity advisor on all things CC says she often finds herself being the perceived as a “dream killer” when educating owners to the inner workings of this process. Established groups often expect the payer rules to be the same as they were …
Read MoreLast Minute Coding Changes for 2021
December brought us some last-minute coding changes. In some cases, this caused a small claim delay as clearinghouses and payers scrambled to update their systems. New ICD-10 Codes for COVID-19 Effective January 1, 2021, there are new ICD-10 codes for reporting COVID-19 related diagnoses. These codes replace the existing codes we are using that are not as specific. There are two other new codes: 81 (Multisystem inflammatory syndrome (MIS)); and 89 (Other specified systemic involvement …
Read MoreFAQ: New E/M Guidelines
It’s 2021, and the new E/M guidelines for office visit codes are here. Hopefully, providers will feel some relief in the amount they need to document and can spend more time treating their patients. This month I’ll answer some of the questions I’ve received. Q. Do all three elements of medical decision-making (MDM) need to be at the same level for the code selected? A. No. Only the two highest elements need to be met …
Read More
What’s New for RCM? Updates on Coding for COVID-19 Testing
As lab testing for COVID-19 continues to evolve, new products—and new CPT codes—continue to emerge. The latest tests combine COVID-19 testing with a test for influenza A and B. There are two types: one includes the polymerase chain reaction (PCR) test, the other includes the antigen test. The new CPT codes are: 87636 Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) and influenza virus …
Read MoreLooking Forward to 2021
2020 has been a rough year for all of us, and everybody is eagerly awaiting 2021. One thing for urgent care providers to look forward to is simplified documentation standards for evaluation and management guidelines. Current documentation guidelines are over 20 years old. A lot has changed in that time, most importantly the adoption of electronic medical records (EMR). Thus, outdated expectations have created “note bloat,” unnecessary work, and contributed to provider burn out. The …
Read MoreTo Flu or Not to Flu
It’s flu season again and this year patients have two viruses to worry about: COVID-19 and influenza. Now is the time patients will come in to get their flu vaccine and (hopefully) take the flu possibility out of the equation. Vaccinations are usually billed with two CPT codes: one for the vaccine and one for the administration of the vaccine. If the practice did not pay for the vaccine, only the CPT code for the …
Read More