Practice Management
Heather Real There are many reasons to start your own urgent care, whether it be feeding your entrepreneurial spirit, investing in an industry that has proven to be stable and growing (even amidst multiple economic crises in the last three decades), or responding to the needs of a community. For many, the reasons include at least some of these, and more. Realizing the desire to take on this project is the first step; however, there …
Read MoreThe urgent care industry is in its fifth decade and still growing! The driving forces of affordability and accessibility continue to fuel this growth. Success has been propelled by the agility of urgent care operators in adjusting their business model to meet the demands of their communities. Initially, urgent care centers were a welcome supplement in communities where the emergency department was the only option for medical care apart from PCPs or specialist offices. Roughly …
Read MoreIt’s been 14 months since the new evaluation and management guidelines took effect. Many providers struggled to modify their documentation after 25 years with the 1995 guidelines. Urgent care practices stepped up with training programs to get through the learning curve with some new concepts. This month I’ll address some of the common questions that we receive. Do I have to meet the level in all the elements to bill a code? No, the level …
Read MoreThe Protecting Medicare and American Farmers from Sequester Cuts Act was signed into law on December 10, 2021. This law addresses the reduction in the 2022 Conversion Factor set by the Physician Final Rule, as reported in my December column, increasing the 2022 Conversion Factor by 3%. The new conversion factor becomes $34.61 compared to $34.89 in 2021. With the increase in Relative Value Units on most E/M codes, the impact to 2022 rates becomes …
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Refunds have always been a challenge in healthcare. Not only do they create an administrative burden but there is also the potential for compliance risk. Some common causes for refunds are: Not validating the patient’s insurance eligibility and collecting the wrong copay amount Choosing a blanket amount to collect from all patients up front regardless of whether they have insurance (ie, over collecting at the time of service) Sending statements too early, causing duplicate payments …
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A common question that I receive is whether COVID-19 testing is still being covered by insurance plans. The Families First Coronavirus Response Act (FFCRA) and the Coronavirus Aid, Relief, and Economic Security Act (CARES) require insurance plans to cover diagnostic testing without cost-sharing (cost-sharing being the amount assigned to patient responsibility; it includes deductibles, copays, and co-insurance). The word “diagnostic” is significant. COVID-19 testing falls into two categories: Diagnostic – used for treatment. Patients are …
Read MoreOne of the biggest challenges for urgent care practices is staffing. Midlevels are a great solution. As states pass laws giving midlevels more autonomy to compensate for physician shortages, however, there is some confusion on how to bill for these providers’ services. I will attempt to answer some of your billing questions. Do I need to credential my midlevels? Yes and no. This is dependent on your contract. For some group contracts, any new provider …
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Every year on October 1, the Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics release an updated ICD-10-CM Official Guidelines, as well as changes to the code set. This year there are 159 new codes, 32 deleted codes, and 20 revised codes, with a total of 72,748 codes to choose from. (Visit ICD-10-CM Official Guidelines for Coding and Reporting FY 2022 at https://www.cms.gov/files/document/fy-2022-icd-10-cm-coding-guidelines.pdf to see the entire document.) Three …
Read MoreIn the May issue of JUCM, we outlined what we were seeing with E/M coding levels utilizing the new AMA guidelines vs 2020 and 2019 levels. As COVID-19 visits steadily declined from January through June, we began to see a return to more “normal” urgent care visits. That was short-lived. July’s sharp increase in visit volumes was again driven by COVID-19! Here’s the update we promised. As a reminder, we saw E/M levels decline in …
Read MoreIn the words of Red Adair, “If you think it’s expensive to hire a professional to do the job, wait until you hire an amateur.” Credentialing dictates how you bill. Do I bill as a group? Should I credential my nonphysician practitioners (NPP)? Which place of service (POS) should I bill with based on my contract? These are all important questions. Did you know that in April of this year, an urgent care chain reached …
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