Journal of Urgent Care Medicine

De Novo vs Acquisition: What’s the Best Pathway for Urgent Care Growth?

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 …

End of the Public Health Emergency: What’s Next?

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 …

Identifying (and Resolving) Common Billing Pitfalls

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 …

Are You Chasing Profitable Growth, or Just Growth?

Heather 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 …

Tips for Payer Reviews

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 …

Where Do You Start When Starting Your Urgent Care?

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 …

New ICD-10-CM Codes in Effect as of October 1

It’s time for the major release of ICD-10-CM that occurs on October 1 every year. For 2023, this update reflects 1,468 new codes, 251 deleted codes, 35 revised codes, and 36 codes converted to parent. Like the last few updates, Social Determinants of Health (SDOH) are front and center. SDOH are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, …

Primed for Growth: Why It’s Time to Consider Adding Primary Care Services to Your Urgent Care Center

Many patients don’t think about “urgent care” until the moment they need treatment. Likewise, few people think of urgent care when considering a routine check-up at the doctor’s office. Perhaps it’s time for that to change. The main demographic served by urgent care consists of “working age” adults, 24-54, and their families. Historically, these patients lack a primary care provider (PCP). Whereas children have a pediatrician and seniors in a Medicare plan are likely served …

A Half Century of Urgent Care: What Today’s Startups Need to Know

The urgent care industry is in its fifth decade and still growing! The driving forces of affordability and accessibility continue to fuel this growth. Success has been propelled by the agility of urgent care operators in adjusting their business model to meet the demands of their communities. Initially, urgent care centers were a welcome supplement in communities where the emergency department was the only option for medical care apart from PCPs or specialist offices. Roughly …

Decreasing Denials and Rejections Through Your Urgent Care Operating Model

A wise person once said, “If a claim is rejected or denied, the energy to get it paid is five times the energy if it went through as a clean claim.” Maybe it is only four times or three times the work, but the point is that we should all do everything we can to avoid rejections and denials! Unlike more complicated specialties subject to complicated coding, authorization, and other factors, in an urgent care …