Clearing Up the Confusion in COVID-19 Testing

There are so many options available for coronavirus disease 2019 (COVID-19) testing. How do you know what test is best for your urgent care center? The need for virus testing was and still is paramount in the fight against this COVID-19 pandemic. The American Medical Association introduced new Current Procedural Terminology (CPT) code 87635, “Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19)], amplified probe technique” on March 13, 2020, also making the code effective that same date of service …
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The Myth of ‘Control’ with In-House Billing

We keep our billing in-house so we can control it. I have been in the revenue cycle management (RCM) business for over 25 years and I guess I have heard this quote from people more than a thousand times. Unfortunately, 95% of the time it is just not true! Having your billing staff in the clinic may make you feel better but, in most cases, there is no control at all. It is just a false sense of security. Consider that actually being in control includes all of the following: …
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The Impact of Public Health Emergency on Revenue Cycle Management

March and April were challenging months for all of us, and the revenue cycle management arena is no exception. A few months ago, we never would have imagined that our everyday lives would grind to such a halt—from schools, sports, concerts, and events canceled to self-quarantines and stay-in-place mandates. The financial markets have lost tremendous value and many people have lost or will likely lose their jobs. In all of this craze, we have seen our urgent care customers rise to the occasion to support their communities and show amazing …
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Contracting and Credentialing: A Complex Obstacle to Navigate

The terms contracting and credentialing are often used interchangeably, but the processes involved in each, while interdependent, are very different and have different outcomes. Contracting, in brief, is the process of creating a formal legal agreement between the payer (insurance company) and the provider (facility, physician, and/or physician extender). The contract outlines expectations and requirements of all parties. The effective date of the agreement, the reimbursement/fee schedule, place of service, termination clauses, services allowed and disallowed, etc. are all included in a typical contract. Credentialing with payers is the process …
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Taking Pictures, Dog Paddling, and Apple Picking: A Metaphorical Approach to Healthy Revenue Cycle Management Metrics

You have seen all the articles about benchmarking and standard revenue cycle management metrics. The repetition of these basic articles is nauseating. This is not one of those articles. To illustrate that, let’s start by asking, what do photography, dog paddling, and apple picking have to do with your urgent care billing? Photography Standard RCM metrics are like the settings on your digital camera. Most people set the camera to Program mode (or “P” for program) and the camera figures everything out for a good picture. Sometimes this works great …
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