Journal of Urgent Care Medicine

CMS Offers Advance Payment For Providers After Hurricane Helene

The Centers for Medicare & Medicaid Services (CMS) announced that it is offering accelerated and advance Medicare payments for providers affected by Hurricane Helene. Those in disaster zones may request the payments individually with their unique National Provider Identifier to improve cash flow issues resulting from impaired operations that might be preventing providers from submitting claims and receiving Medicare payments. CMS notes Medicare providers that need assistance should contact their assigned Medicare Administrative Contractor. It’s …

ICD-10-CM: What’s New for 2025

Phyllis Dobberstein, CPC, CPMA, CPCO, CEMC, CCC We are heading into fall, and fall starts with updates to the ICD-10-CM codes. The most recent changes went into effect on October 1, 2024. There is no grace period. Because ICD-10-CM codes are date-specific, claims prior to date of service October 1, 2024, need to use the codes for that time period, switching over to the update on the exact day. While ICD-10-CM codes are updated semi-annually, …

Avoid CLIA-Waived Testing Violations in Urgent Care

Urgent message: Most of the laboratory testing that occurs in urgent care consists of simple, on-site tests that are “waived” from federal CLIA regulations—but urgent care centers must still comply with standards affecting their CLIA waiver. All facilities in the United States that perform laboratory testing on human specimens for health assessment or the diagnosis, prevention, or treatment of disease are regulated under the Clinical Laboratory Improvement Amendments of 1988 (CLIA). CLIA requires laboratories to …

2018 ICD-10-CM: A Preview of Urgent Care-Relevant Changes

It’s again time to review what has changed with the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) effective October 1, 2017 through September 30, 2018. There are 360 new, 142 deleted, and 226 revised diagnosis codes in the final update. We will review the changes most relevant to urgent care, but the examples shown here are not all-inclusive. You can find all updates in the Centers for Medicare and Medicaid Services (CMS) website …

UCA Files Comments on Medicare QPP

The Urgent Care Association vowed to represent the industry’s interests when the Centers for Medicare and Medicaid Services (CMS) released its final rule implementing the Medicare Access and CHIP Reauthorization Act (MACRA) last October. In effect, CMS imposed guidelines for clinicians participating in Medicare’s Quality Payment Program (QPP), and defined two possible pathways: the Merit-Based Payment Incentive Program (MIPS) or the Advanced Alternative Payment Models (APMs). UCA made good on its promise this week by …

CMS Ups Its Game in Going After Medicare Fraud

Recent headlines have put Medicare fraud—and the search for those committing it—in the spotlight. However, urgent care clinicians who toe the line in treating Medicare patients are less likely to face unwarranted audits in the future—while fraudsters are putting themselves more at risk than ever—under a new system revealed by the Centers for Medicare and Medicaid Services (CMS). The agency is essentially narrowing the scope of practices it will investigate for fraud, hoping it will …

E/M Coding Could Be Heading for an Overhaul

The Centers for Medicare and Medicaid Services says providers have been clamoring for an update of the 1995 and 1997 guidelines for evaluation-and-management (E/M) codes—and it may be ready to oblige them. If it goes forward, the plan would take years to implement and focus mainly on revising the history and physical exam portion of a patient encounter. The aim, according to CMS, would be to simplify and better align E/M coding and documentation, presuming …

CMS May Cut Payments for Off-Campus Hospital Visits by Half

Hospital-owned urgent care centers—many of which became “hospital-owned” thanks to a relatively generous 50% reimbursement rate for off-campus patient visits—may be taking a substantial hit if the Centers for Medicare and Medicaid Services follows through on a plan to cut that rate by half. Hospital administrators say even though running off-campus clinics increases their operating budgets, they enable health systems to offer more patients access to cost-effective care. On the other hand, the Trump administration …

Most Doctors Say They’re Not Prepared for MACRA

We told you recently that the Centers for Medicare and Medicaid Services lowered the threshold for physicians to be exempt from MACRA’s reporting requirements in 2018. It’s a good thing, too: 75% of physicians involved in practice decision-making say they do not feel well prepared to participate in MACRA’s Quality Payment Program (QPP). The data were just released by the American Medical Association and KPMG. The QPP pushes eligible providers to choose between the Advanced Alternative …

CMS May Have Overpaid $729 Million in Incentives—Now They Want It Back

The Centers for Medicare and Medicaid Services (CMS) may have doled out more than $729 million in incentive payments for use of electronic health record systems that didn’t actually comply with federal standards, according to the Office of the Inspector General (OIG) at Health and Human Services. The OIG has already uncovered instances where providers who received payments could not document that they were using electronic health records in “meaningful” ways—a key requirement to reap …

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