Phyllis Dobberstein, CPC, CPMA, CPCO, CEMC, CCC Archives

Benefits of Adding Primary Care Services to Your Urgent Care

Phyllis Dobberstein, CPC, CPMA, CPCO, CEMC, CCC In the last few years, the Centers for Medicare & Medicaid Services (CMS) has accelerated its long-term effort to strengthen primary care as the foundation of the U.S. health system. Through new payment models, regulatory changes, and equity-driven initiatives, CMS aims to rebalance healthcare spending toward prevention, care coordination, and whole-person health. All these are areas historically underfunded compared to specialty or hospital care. Major policy changes have …

Billing Integrity in Urgent Care: How to Manage Risk

Phyllis Dobberstein, CPC, CPMA, CPCO, CEMC, CCC, is Revenue Integrity Manager at Experity. The financial and reputational health of an urgent care practice depends on one simple principle: Bill accurately and compliantly. Yet as reimbursement rules evolve and staffing models shift toward greater reliance on non-physician practitioners (NPPs), many centers find themselves at risk for costly missteps. From billing under the wrong provider to out-of-network (OON) complications and False Claims Act (FCA) violations, administrators are …

Mastering Revenue Cycle Management

Phyllis Dobberstein, CPC, CPMA, CPCO, CEMC, CCC Revenue cycle management (RCM) may not be the most glamorous part of urgent care, but it is one of the most critical. A clinic can provide excellent patient care, yet still struggle to keep its doors open if its billing processes falter. Too often, urgent care leaders rely on assumptions, outdated practices, or incomplete data that lead to financial surprises and lost revenue. Running an effective Revenue Cycle …

Credentialing: The Gatekeeper of Access and Reimbursement

Phyllis Dobberstein, CPC, CPMA, CPCO, CEMC, CCC In the healthcare ecosystem, credentialing is more than a bureaucratic hurdle—it’s the linchpin of successful revenue cycle management. For urgent care centers, credentialing determines whether providers can be reimbursed for the care they deliver to insured patients and whether they can participate in insurer networks. Credentialing is the formal process by which payers—commercial insurance companies, Medicare, and Medicaid—verify the qualifications, training, licensure, and work history of care providers. …

Navigating Payer Reviews and Medical Decision-Making: A Critical Guide for Urgent Care

Phyllis Dobberstein, CPC, CPMA, CPCO, CEMC, CCC Urgent care operators face increasing challenges from payer reviews—a situation exacerbated by ongoing confusion around coding guidelines and proper documentation of medical decision-making (MDM). As more urgent care providers grapple with administrative burdens and financial pressures, understanding how to document and code accurately has never been more important. The Rise of Payer Reviews Pre-payment reviews have become commonplace, initiated when a provider’s billing patterns—such as a higher frequency …

Refresher: Guidelines for E/M Coding

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 …

What’s New in Telemedicine for 2025?

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 …

How ‘Data Reviewed’ Works When Coding E/M

Phyllis Dobberstein, CPC, CPMA, CPCO, CEMC, CCC Three elements determine the level for evaluation and management coding (E/M). “Amount and/or Complexity of Data to be Reviewed and Analyzed” is 1 of them and also the most confusing. Data Reviewed remained a point system after guidelines changed in 2021. As an auditor, I see both undercoding and overcoding in E/M caused by not applying the rules correctly. Let’s start with what tests count toward Data Reviewed. …

ICD-10-CM: What’s New for 2025

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, …

What Did We Learn From the Change Healthcare Outage?

Phyllis Dobberstein, CPC, CPMA, CPCO, CEMC, CCC Nearly all of us in the healthcare ecosystem were impacted by the cyberattack on Change Healthcare in February that caused widespread network disruptions. Change Healthcare processes 15 billion healthcare transactions annually and is connected to one-third of patient medical records in the United States. More than 100 Change Healthcare applications across pharmacy, medical, dental, patient engagement, and payment services were affected by the disruptions. Months later, United Health Group …

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