Journal of Urgent Care Medicine

Attention Small Urgent Care Operators: CMS May Lower Threshold for MACRA Exemptions

Centers for Medicare & Medicaid Services has broadened the definition of “small providers” as it applies to the Medicare Access and CHIP Reauthorization Act of 2015, to the extent that physician practices with less than $90,000 in Medicare revenue or fewer than 200 unique Medicare patients per year would be exempt from having to comply with MACRA. Between this new standard and the one proposed for next year, the move will exclude roughly 834,000 more …

Medicare ID Changes Are Looming, with or without Clear Guidance from CMS

Here’s what we know: The Centers for Medicare and Medicaid Services (CMS) is going to stop including Social Security numbers on Medicare ID cards. Here’s what we don’t know: How this is going to work, and how it’s going to affects healthcare providers. The Medicare Access and CHIP Reauthorization Act requires CMS to remove Social Security numbers from Medicare cards due to increasing risk for identity theft and fraud. The year-long process of issuing new …

Urgent Care is One Focus of New CMS Antibiotic Stewardship Initiative

As antibiotic resistance continues to grow, organizations from the Urgent Care Association of America to the Antibiotic Resistance Action Center to the Centers for Disease Control and Prevention have asked their audiences to take a close look at what they can do to curb unnecessary prescriptions that exacerbate the problem. (The cover article in the May issue of JUCM will look at how one institution tackled this problem, as well.) Now the Centers for Medicare …

Panel: CMS Not Doing Enough to Inform Physicians of Changes to Medicare Cards

The Centers for Medicare & Medicaid Services is going to issue new Medicare cards, replacing beneficiaries’ Social Security numbers with unique ID numbers, by April 2019. However, the Health & Human Services Advisory Panel on Outreach and Educations says CMS isn’t doing enough to share more about the process with healthcare providers, who will have to make significant changes in their billing practices as the new ID card system is implemented gradually; CMS will start …

Maximizing Reimbursement for Services on Campus, off Campus, or on the Phone

Q: We are coding for an urgent care group that is owned by a hospital and bills on a CMS-1500 for professional services and the UB-04 for facility services. We bill using Place of Service (POS) code 22. Is this correct? A: Prior to January 1, 2016, the Centers for Medicare and Medicaid Services (CMS) POS code set did not differentiate between an urgent care operating on campus or off campus. As of January 1, …

Alabama May Lose Medicaid Funding for Cutting Off Some Enrollees

Alabama says it’s just trying to protect its coffers from being pilfered by criminals, but the Centers for Medicare & Medicaid Services is taking a hard look at how the state is handling cases of alleged fraud by Medicaid enrollees. The state acknowledges that it rejects people who would otherwise be eligible for Medicaid funding if those individuals “have been found” to have engaged in fraud—even if they were never convicted of a crime, which …

Health Spending Predictions Favor Urgent Care

The next decade will see national health expenditures grow 5.6% annually, according to projections from the Centers for Medicare & Medicaid Services (CMS), ensuring that the need for cost-effective, high-quality care will continue to grow as well. If CMS’s Office of the Actuary is correct in its estimate, the jump in healthcare spending will outpace projected growth of the Gross Domestic Product (GDP) by 1.2%. The portion of the GDP consumed by healthcare spending is …

CMS Says Maryland ‘Tops’ the List for ED Wait Times

The Centers for Medicare & Medicaid Services (CMS) says patients reporting to emergency rooms in Maryland are likely to wait over twice as long as the national average—53 minutes vs 22 minutes. Greater Baltimore Medical Center (BMBC), whose ED clocked an average wait time of 60 minutes, suggested patients could get in and out much more efficiently if nonemergent patients sought care in a more appropriate environment, such as BMBC’s primary care offices. This echoes …

Splint and Cast Application Performed by Someone Other than Physician

Q: Can you bill for splint and cast applications done by someone on staff other than the physician? A: Yes, you can still bill for the service if the application is performed by someone else in the clinic. The American Medical Association (AMA) provided guidance on this in the Current Procedural Terminology (CPT) Assistant, April 2002 issue: “You will note that the reference to ‘physician’ has been retained in the clinical examples provided. This inclusion …