Practice Management
Phyllis Dobberstein, CPC, CPMA, CPCO, CEMC, CCC Hard to believe that the new evaluation and management (E/M) guidelines have been in place for urgent care for 4 years. These guidelines created by the American Medical Association (AMA) were a complete shift from what was previously published by the Centers for Medicare & Medicaid Services. Instead of bullet points, levels are determined by the work involved in treating a patient. E/M codes can be leveled by …
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Phyllis Dobberstein, CPC, CPMA, CPCO, CEMC, CCC The American Medical Association (AMA) added a Telemedicine Services category to the Evaluation and Management (E/M) section of the Current Procedural Terminology (CPT) code set. Codes are divided up by the technology used and the patient type (ie, new vs. established). These codes are for synchronous, real-time interactive encounters between the provider and the patient. Codes are leveled by medical decision making (MDM) or time, which is similar …
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We are deep into the fourth quarter of 2024, and you are probably preparing for the holidays and wrapping up year-end projects. As we celebrate the end of the year, it is important to also look ahead and lay the groundwork for revenue cycle management success in 2025. Following are some points to consider in your strategic plan for next year. Contract Renegotiations Understanding your payer agreements and your patient population will be instrumental to …
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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, …
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Over the past 2 decades, urgent care has been on the forefront of consumerism. Increasingly, healthcare consumers are realizing how much they are contributing to the cost of healthcare delivery through taxes and payroll premium deductions, and therefore, they’re more motivated than ever to attain the full value of the benefits they’ve paid for. Urgent care has remained focused on the consumers’ sense of value by appealing directly to patients as clinics market their convenient …
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Heather Rothermel When considering contracting for your clinic, it will be important to know how you plan to market your clinic and to ensure that you align with the needs of your community. Will you be a primary care practice, an urgent care practice, or a blended practice? Thoroughly analyzing your market and competition should help guide this decision, but there is a bevy of things to consider—everything from contract type, credentialing requirements, reimbursement methodologies, …
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Benjamin Barlow, MD; Phyllis Dobberstein, CPC, CPMA, CPCO, CEMC, CCC The False Claims Act (FCA) is a federal statute enacted in 1863, inspired by defense-contractor fraud during the Civil War. Today it is used to prosecute inappropriate billing in the healthcare setting. Any person who knowingly submits false claims to the government (ie, Medicare, Medicaid, and Tricare) is liable for 3 times the government’s damages plus a penalty that is linked to inflation. Penalties are per …
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Benjamin Barlow, MD; Phyllis Dobberstein, CPC, CPMA, CPCO, CEMC, CCC One of the biggest challenges facing urgent care operators is increased scrutiny in the form of payer reviews. More clients than ever are facing these administrative and financial burdens. Compounding the issue is that urgent care clinicians often struggle to understand coding guidelines and how to document in a way that shows their medical decision making, which is vital in care and in payer reviews. Prepayment …
Read MorePhyllis Dobberstein, CPC, CPMA, CPCO, CEMC, CCC, is RCM Compliance Manager, Experity With the fall season comes all the coding changes for the year. This starts with the 2024 edition of the ICD-10-CM codes, which went into effect on October 1, 2023. As a reminder, there is no grace period. Changes are effective on dates of service as of October 1. Prior to this date, practices should continue to use the 2023 ICD-10-CM code set. This …
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Phyllis Dobberstein, CPC, CPMA, CPCO, CEMC, CCC Modifier 25 is used to indicate a significant, separately identifiable evaluation and management (E/M) service was required on the day of a minor surgical procedure. The procedure performed must have a global period of 0 or 10 days. An example of this is a laceration repair. Modifier 25 is overused in the industry and has been under scrutiny from payers for decades. Now private payers are implementing policies …
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