Revenue Cycle Management

Urgent care centers serve a crucial function in providing prompt and accessible healthcare, but they encounter unique challenges in managing their revenue cycle, particularly in reducing claim denials. Unlike primary care or specialized medical practices, urgent care clinics often treat patients on a one-time basis, making both patient intake and billing more complex. Additionally, frequent turnover among front desk staff contributes to recurring errors in patient registration, insurance verification, and claims processing, all of which raise the likelihood of denials. Denied claims can delay reimbursements, increase administrative burdens, and negatively …
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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 either medical decision making (MDM) or time. Here is a summary of the guidelines to …
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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 to the office visit codes. CPTTechnologyPatient TypeMDMTime Minimum98000Audio-videoNewStraightforward15 minutes98001Audio-videoNewLow30 minutes98002Audio-videoNewModerate45 minutes98003Audio-videoNewHigh60 minutes98004Audio-videoEstablishedStraightforward10 minutes98005Audio-videoEstablishedLow20 minutes98006Audio-videoEstablishedModerate30 minutes98007Audio-videoEstablishedHigh40 …
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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. Lab tests—whether performed in-house or sent out to a laboratory—always count toward Data Reviewed. Labs …
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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 successful contract renegotiations in 2025. Once your agreement has met its initial term, you can …
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