Journal of Urgent Care Medicine

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 …

Can 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 …

The Incidentals of ‘Incident-to’ Billing

Q: I plan to hire physician assistants and other nonphysician providers in my urgent care clinic. I understand that I can use “incident to” billing to have their patient visits reimbursed at the physician rate. What are the rules for “incident-to” billing? A: The Centers for Medicare and Medicaid Services (CMS) defines “incident to” as “those services that are furnished incident to physician professional services in the physician’s office (whether located in a separate office …

Independence Blue Cross Slashes Reimbursements on Modifier 25

Independence Blue Cross has implemented a new policy that cuts reimbursements on procedures billed with modifier 25 (“Significant, separately identifiable E/M service”) by half for care given to Medicare Advantage members and patients covered by private insurance plans. The lower rate does not apply to traditional Medicare claims. Independence covers patients under its own name, but also through QCC Insurance Company, Keystone Health Plan Eastand AmeriHealth. The move sets Independence apart from other payers, including …

In Texas, Progress Toward Prohibiting ‘Surprise Billing’ by Freestanding ERs

Protecting patients against the suspect billing practices—especially “surprise billing”—of freestanding emergency rooms seems to be a high priority in the Texas legislature. Most recently, a bill that offers patients more ways to contest bills was signed into law; Senate Bill 507 expands the use of mediation to contest surprise medical bills. This problem is perceived as especially great in Texas, which is home to more than half of the freestanding ERs in the country. Further, …

Freestanding ERs Criticized for Billing—and Cherry-Picking Wealthy Patients

The rapid growth of freestanding emergency rooms—as well as consumer outrage over controversial billing practices—continues to draw the attention of researchers and legislators around the country. Most typically found in affluent neighborhoods, some freestanding emergency centers can be hard to distinguish from lower cost urgent care centers, setting expectations for some patients that they’ll receive an urgent care-size bill. When the cost more closely resembles the cost of a trip to the ED, patients cry …

Make More Profitable Billing Practices a New Year Resolution for 2016

It’s not news that operating margins can be very thin—making it all the more perplexing that so many practices leave money on the table by not billing or coding correctly. While the Centers for Medicare and Medicaid Services has said it will not deny claims for incorrect codes during the first year following implementation of ICD-10 in October 2015, provided that submitted codes are within the right code family, that’s only the tip of the …

October 1: Out with ICD-9, in with ICD-10

“Urgent care” was in its infancy and electronic medical records were practically the stuff of science fiction when the ICD-9 codes were released in 1979. The Centers for Medicare and Medicaid Services (CMS) takes one giant leap toward catching up with the launch of ICD-10 codes on October 1. As of that date, ICD-9 codes will no longer be accepted. CMS has said the new coding set is expected to “advance public health research and …

Minding Your E’s & M’s

Nothing hurts a business more than leaving money on the table. It is hard enough to attract business; the last thing you want to do is not get paid once services are rendered. There are a number of steps in the coding and billing process, and errors at any level can lead to bad debt, missed charges, and poor reimbursement. Let’s look at a few I would call the “low-hanging fruit.” Collection at the Time …