Journal of Urgent Care Medicine

New vs. Established Patients, Medicare Exam, ICD-10 Delay

Q. A patient with Medicare as his primary insurance needs a physical and EKG for clearance for an MRI with sedation ordered by his neurologist. Symptoms are imbalance along with pain in the shoulder, neck, and upper spine. Can I use the pre-op code V72.81 because there is sedation even though there is no actual surgery? Or should I just get a signed Advanced Beneficiary Notice (ABN) and expect a denial? A. Yes, you can …

The First Thing We Do, Let’s Kill All The Lawyers

DAVID WEIN, MD, MBA, FACEP, and DENNIS DIXON, MD I knew that would get your attention! Actually who Shakespeare was referring to in Henry VI was only the rare corrupt lawyer. Corrupt or not, the one thing lawyers have correct is that because their entire practice is “giving advice,” they rarely do it for free. Bad advice has consequences. I’m not trying to be Doctor Downer but in medicine and law, it’s called negligence. As …

An Urgent Care Operator’s Guide to Hiring and Managing a Lawyer

Urgent message: This article is a broad overview of how lawyers work and charge and what to do to avoid some of the most common pitfalls inherent in the attorney-client relationship. ALAN A. AYERS, MBA, MAcc Practice Velocity Success in business entails being prepared and there will be times when it’s unavoidably necessary for you, the urgent care operator, to engage the services of an attorney. From structuring and starting up the business, to reviewing …

What Percentage of Patients Do Urgent Care Centers Transfer or Direct to an Emergency Room?

These data from the 2012 Urgent Care Industry Benchmarking Study are based on a sample of 1,732 urgent care centers; 95.2% of the respondents were UCA members. Among other criteria, the study was limited to centers that have a licensed provider onsite at all times; have two or more exam rooms; typically are open 7 days/week, 4 hours/day, at least 3,000 hours/year; and treat patients of all ages (unless specifically a pediatric urgent care).

DME, Benign Lesion Excision, Urgent Care Codes

Q. We currently provide DME to our patients as a courtesy to them and then bill their insurance. We generally get paid by most private insurances, but not by Medicare. Our billing department claims Medicare will never pay for any DME we provide because we are not a DME provider licensed with Medicare. If our billing department is correct, would it be compliant to give DME prescriptions to all patients 65 and over? A. I …

Scribes in the Urgent Care

DAVID WEIN, MD, MBA, FACEP, and DENNIS DIXON, MD For years I was subjected to corporal punishment at the hands of nuns who used to beat me when they could not read my handwriting – at least that is how I remember it. For reasons unknown, my handwriting was never legible. Even back in the day, using the T-System’s “slash and check” charting, my medical records looked like I had either DTs or Benign Essential …

HIPAA for Urgent Care Centers: A Primer

Urgent message: This article discusses potential penalties for violations of HIPAA and key steps urgent care centers should take in order to avoid such penalties. BART WALKER and MEGGAN BUSHEE Complying with the Health Insurance Portability and Accountability Act (HIPAA) can be a daunting challenge for smaller providers. As the urgent care industry grows, its providers will become much more visible targets for scrutiny by the federal government with respect to HIPAA compliance. In addition, …

What Percentage of Patients Do Urgent Care Centers Send Elsewhere for Diagnostic Tests?

MDM, E/M Code with Injection Codes

Q. I was approached by a member of the hospital billing department who does urgent care (office based practice) and emergency department billing about a coding question. As the medical director, they asked for my thoughts and support. It’s nice to work at a place that includes the docs! The question revolves around prescription drug management within the management options under the medical decision making (MDM) section pertaining to E/M calculation. We currently do not …