Urgent Care Billing: Best Practices Scorecard

When it comes to measuring your financial performance, metrics translate the actions of others into insight. They provide visibility into the efficacy of your overall billing process. But while they may shine a light on where you need to improve, they don’t tell you how to do it. For a better understanding of how well your clinic is optimizing the billing process, look at your everyday practices. Our revenue cycle management (RCM) experts compiled 10 questions that reflect how well you’re set up to be paid timely and correctly. Complete …
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2021 E/M Guidelines: Your Questions Answered

It’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 is based on two out of three of these elements: problems addressed, risk of management …
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What Else is New in 2022?

The 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 minimal. (See Table 1.) Without this action by Congress, we would have seen an average …
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Refunds: How to Avoid Them

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 amountChoosing 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 Is a credit balance always a refund? No. Credit balances require research to determine if they are …
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Cost-Sharing, Health Insurance Plans Waiving Cost Sharing

Are Insurance Plans Still Waiving Cost-Sharing?

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 symptomatic or asymptomatic but exposed.Screening – used for administrative purposes. Patients are asymptomatic and have …
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