Journal of Urgent Care Medicine

‘Rampant’ Medicare Overbilling Highlights Need for Cost-Efficient Care

Medicare was overbilled by 12.1% in 2015, thanks to improper fee-for-service reimbursements in 21 states, according to the Centers for Medicare & Medicaid Services (CMS). That’s up from 8.6% just five years ago, making it one of the highest error rates in history. Louisiana was the worst offender, with an overbilling average of 19.4%—equating to over $1.2 billion in excess fees. Texas and Georgia also showed over a billion dollars in overcharges to Medicare last …

New CMS Rule Hands Telemedicine Oversight to States

A new ruling from the Centers for Medicare & Medicaid Services (CMS) standardizes the responsibility of state Medicaid agencies when it comes to telemedicine, aiming to ensure that “proper access to particular healthcare services can be ensured.” Those assessments would include the needs of patients, as well as time, distance and access afforded by telemedicine. Each state will be responsibility for policing itself by evaluating performance of those services every three years. Once the rule …

Electrocardiogram Data Points and Evaluation and Management Visit Level; Gait Training

Q. When counting data points for the complexity of medical decision-making (CMDM) portion of the evaluation and management (E/M) visit level, what is the correct way to assign data points for an electrocardiogram? For example, the Current Procedural Terminology (CPT) code is 71020 for a chest radiograph with interpretation and report. The description itself has the interpretation and analysis included in the code already. Is it considered double-dipping if we count the interpretation as 1 …

Planning for Meaningful Use? The Clock Is Ticking

Urgent message: CMS offers stimulus funds to providers who “attest” that their EHR use improves patient care: up to $18,000 in 2011 alone. The sooner you do, the more you stand to earn. ERIC McDONALD “Meaningful use” refers to the use of a “certified” electronic health record (EHR) to meet specific objectives established by the Centers for Medicare & Medicaid Services (CMS), which administers the EHR incentive program. An EHR is certified when it demonstrates …

Evaluation and Management: Coding Details

Q.Why is the (E/M) code important in urgent care? A.Because the majority of urgent care revenue is derived from E/M codes (mostly codes 99210-99215), accurate E/M coding is the most important coding variable in urgent care revenue. Inaccurate E/M coding is, also, the number-one reason that urgent care centers run into compliance issues with payors and regulatory agencies. Q.I see that the Centers for Medicare and Medicaid Services (CMS) lists two sets of guidelines, 1995 …