Practice Management
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 …
Read MoreQ: 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 …
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Urgent care doctors, physician assistants, and nurse practitioners who did not demonstrate that they met requirements for meaningful use of electronic health record systems as mandated by the Centers for Medicare & Medicaid Services (CMS) will see a 3% decrease in Medicare payments starting January 1, 2017. As you read here, CMS first announced its plans to require clinicians to show meaningful use during a finite 90-day period that year. That finite period was later …
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The Centers for Medicare and Medicaid Services (CMS) will ask Medicare beneficiaries how their healthcare providers are doing under the new Merit-based Incentive Payment System (MIPS), which was supposed to help improve the quality of care while lowering cost. No revelations are expected, however, because the survey is voluntary and CMS has taken a relaxed approach to getting providers on board with the new system. In addition, survey results—which, presumably, will be made public to …
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Changes in the way the Centers for Medicare & Medicaid Services (CMS) pays for primary care will push roughly $140 million to providers next year—with provisions in a new rule bringing another $60 million for a total of $200 million above 2016 payments. There may be even more coming down the road, as CMS says several coding and payment changes could eventually lead to as much as $4 billion or more being funneled into care …
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The Urgent Care Association (UCA) sent a letter to the Centers for Medicare and Medicaid Services (CMS) in favor of lowering the copay patients would be responsible for when visiting an urgent care visit, effective in 2018. The changes would affect the cost-sharing structure for “standardized options” (ie, Simple Choice plans) that plan issuers offer in the individual insurance marketplace. Standardized options are intended to simplify the consumer plan selection process; each has a single …
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The Urgent Care Association (UCA) has officially filed comments with the Centers for Medicare and Medicaid Services (CMS), supporting a proposal to modify the “24/7” access requirements for providers who plan to bill Medicare for Chronic Care Management (CCM) codes. According to UCA, the new language will allow primary care providers “to more easily meet the CCM billing requirements if they contract with urgent care centers for their patient’s acute care needs, including evenings and …
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Major changes are afoot for urgent care centers that treat patients under Medicaid and the Children’s Health Insurance Program (CHIP), thanks to a new rule the Centers for Medicare and Medicaid Services (CMS) is imposing. In addition to new requirements for insurers, the rule also creates new compliance and administrative burdens that could affect revenue for medical practices (eg, requiring care coordination between different settings and institution of quality-rating systems and allowing states to encourage …
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The aging population—clearly not a controllable factor—is high on the list of factors that will continue to drive up healthcare spending over the next decade, according to the just-released 2016 National Health Expenditures Report from the Centers for Medicare & Medicaid Services (CMS). National healthcare spending is projected to grow at a 5.8% annual rate, starting last year through 2025. If accurate, that means healthcare spending will rise from 17.5% in 2014 to 20.1% as …
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William Rodney, MD couldn’t jump fast enough when he found out the Affordable Care Act (ACA, or “Obamacare”) would be raising Medicaid primary care payments to Medicare levels. His urgent care practice (featured here previously; see One Year In, Latino-focused Clinic Doubles in Size) took in enough additional fees to create an outreach clinic for bilingual uninsured patients and to provide x-rays, ultrasound, and other services for underserved communities in Tennessee. Now he’s worried about …
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