Journal of Urgent Care Medicine

Patients Confused by ‘Urgent Care’ Label on Hospital EDs

How free-standing emergency departments (EDs) present themselves to the community continues to cause confusion for patients, ultimately leading to unexpectedly higher medical bills and negative overall experiences. Some free-standing EDs have the term “urgent care” in their name, which many believe is misleading. And now there is at least one effort to investigate a class action lawsuit for patients who accessed what they believed was urgent care—based on the facility’s sign out front—only to find …

UCA Highlights Bipartisan Effort to Encourage Use of UC

The Urgent Care Association (UCA) recently led a new effort that asks the Centers for Medicare and Medicaid Services (CMS) to include policies in the forthcoming FY 2025 Physician Fee Schedule that would encourage those covered by Medicare and Medicaid to seek non-emergent care at urgent care centers. A letter written by Ann Kuster (D-NH), Brad Schneider (D-IL), Darin LaHood (R-IL), and Michael Burgess (R- TX) that was signed by 26 members of Congress from both …

Make Sure Your Medicare Claims Are Spot-On—or Pay the Price (Literally)

An urgent care operator in upstate New York has agreed to pay $110,000 to settle charges that it submitted false claims to Medicare. The U.S. Attorney for the region alleged that between January 2013 and October 2015 the company billed over 99% of its Medicare fees as if services had been provided or supervised directly by a physician, even though at least some of them had been provided by advanced practice providers (ie, nurse practitioners …

MedPAC Wants to Cut Reimbursements to Off-Campus, 24-Hour Hospital EDs

Medicare reimbursements to many freestanding emergency rooms will be cut significantly if a new recommendation by the Medicare Payment Advisory Committee (MedPAC) is implemented. MedPAC voted unanimously to reduce reimbursements to off-campus, 24-hour hospital EDs located in urban areas within 6 miles of an on-campus ED by 30%. According to an Erdman analysis of the proposal, freestanding, off-campus EDs typically have lower operating costs than on-campus EDs but receive the same Medicare payments—giving them higher …

Ready or Not, Here Come the New Medicare Cards

It’s going to take a year for the whole batch to be in place, but your front desk staff will start seeing new Medicare cards this month. As we told you when the Centers for Medicare and Medicaid Services first announced its plans, every Medicare member will be issued a unique ID number to replace their Social Security number on the cards to better protect all manner of personal information tied to the SSN. Patients’ …

Amazon, Berkshire Hathaway, JPMorgan Chase Circle the Wagons to Cut Healthcare Costs

Three gigantic—and extremely wealthy—corporations are joining forces to try to lower what their leadership considers to be exorbitant healthcare costs. Amazon, Berkshire Hathaway, and JPMorgan Chase say they’re forming an “independent healthcare company” specifically for their employees—more than a million people, though not all are in the U.S. The new entity will focus on technological solutions to lower costs, simplify coverage, and increase transparency in employee healthcare. Berkshire Hathaway’s Warren Buffet says the triumvirate “does …

Get the Most Out of Providing Medicare Wellness Exams

Q: Are there specific requirements for Medicare wellness exams and who can perform them? A: Medicare offers an initial preventive physical examination (IPPE), which is also known as the “Welcome to Medicare” preventive visit or the annual wellness visit (AWV). Either a physician (a doctor of medicine or osteopathy) or a qualified nonphysician practitioner (a physician assistant, nurse practitioner, or certified clinical nurse specialist) can provide the services. The IPPE is a one-time initial examination …

An Update on MIPS Readiness

If you read this newsletter and JUCM, you know the Merit-based Incentive Payment Systems (MIPS) offers a few options in an attempt to encourage participation and allow providers, essentially, to customize their participation to suit their practice. That includes when they start participating, within some limits. And if you read any news sources at all, you know there are more than a few wrinkles in the rollout. With that in mind, here are a few …

Telehealth Growth Highest in a Trio of Subsegments

As telehealth continues to take root as a viable way to administer care, especially for patients in rural areas, a few subsegments are seeing sharper growth than others. Codes for specialty telehealth (which includes inpatient and outpatient care, ED visits, and postacute care consults) for Medicare beneficiaries were applied 191,000 times in 2015, according to new data from Advisory Board. In addition, the volume of telebehavioral health services provided grew 16-fold between 2012 and 2013, …

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 …

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