Credentialing: Why Should I Hire a Professional?

In 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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Can I Bill Patients for COVID-19 Vaccine Administration?

As practices start offering vaccinations for COVID-19 to their patients, we are getting a lot of questions about whether the patient can be billed for the administration. The answer is an emphatic No. The Office of the Inspector General has received complaints from patients about charges by providers when getting their COVID-19 vaccines. So, on April 15, 2021, the Principal Deputy Inspector General Christi A. Grimm issued a message regarding provider compliance with the COVID-19 …

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Pandemic Fluctuations: A Historic Drop, Then a Meteoric Rise in Patients Visits Per Day

Just to confirm, the COVID-19 pandemic has generally not been kind to the urgent care industry. Locations that could get their hands on testing supplies at the outset were inundated with patients clamoring to know if they had the virus. The many facilities that got shut out of test distribution chains suffered greatly, though—as did the industry as a whole. Now, even as case loads continue to climb again in many states, the public’s panic …

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New Technical Corrections Issued by the AMA Explained

On March 9, 2021, the American Medical Association updated the new evaluation and management (E/M) coding guidelines with technical corrections. These clarifications apply to the office visit codes 99202–99215 and are retroactive to January 1, 2021. In the past few months there has been industry confusion over whether a test can be counted under the data element for the E/M level when the practice is also billing for the test. The AMA has answered this …

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Credentialing and Contracting: What to Expect When Expanding

For those trying to grow their urgent care business, conversations around payer contracting and credentialing (CC) can often be overwhelming and seem contradictory to the mission of On-Demand Care. Tammy Mallow, our resident Experity advisor on all things CC says she often finds herself being the perceived as a “dream killer” when educating owners to the inner workings of this process. Established groups often expect the payer rules to be the same as they were …

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Last Minute Coding Changes for 2021

December brought us some last-minute coding changes. In some cases, this caused a small claim delay as clearinghouses and payers scrambled to update their systems. New ICD-10 Codes for COVID-19 Effective January 1, 2021, there are new ICD-10 codes for reporting COVID-19 related diagnoses. These codes replace the existing codes we are using that are not as specific. There are two other new codes:  81 (Multisystem inflammatory syndrome (MIS)); and 89 (Other specified systemic involvement …

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FAQ: New E/M Guidelines

It’s 2021, and the new E/M guidelines for office visit codes are here. Hopefully, providers will feel some relief in the amount they need to document and can spend more time treating their patients. This month I’ll answer some of the questions I’ve received.  Q. Do all three elements of medical decision-making (MDM) need to be at the same level for the code selected? A. No. Only the two highest elements need to be met …

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What’s New for RCM? Updates on Coding for COVID-19 Testing

What’s New for RCM? Updates on Coding for COVID-19 Testing

As lab testing for COVID-19 continues to evolve, new products—and new CPT codes—continue to emerge. The latest tests combine COVID-19 testing with a test for influenza A and B. There are two types: one includes the polymerase chain reaction (PCR) test, the other includes the antigen test. The new CPT codes are: 87636  Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) and influenza virus …

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Turning Back the Tide of Antibiotic Resistance, One (Unfilled) Prescription at a Time

According to JUCM’s own chart research, antibiotics are the most-prescribed class of medications in urgent care. This is not surprising, given that six of the top 10 presenting complaints in urgent care encompass possible diagnoses for which an antibiotic could be an appropriate choice.1             Still, there’s no denying that antibiotics have been overprescribed across the board—in retail clinics, emergency room, traditional primary care offices, and urgent care. This was clearly validated in a research …

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Looking Forward to 2021

2020 has been a rough year for all of us, and everybody is eagerly awaiting 2021. One thing for urgent care providers to look forward to is simplified documentation standards for evaluation and management guidelines. Current documentation guidelines are over 20 years old. A lot has changed in that time, most importantly the adoption of electronic medical records (EMR). Thus, outdated expectations have created “note bloat,” unnecessary work, and contributed to provider burn out. The …

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