Coding Q&A

Click Here to the download PDF. With expiration of the national Public Health Emergency (PHE) as of May 11, the revenue cycle management (RCM) industry has to adjust to the “new normal.” Some emergency declarations were tied to the end of the PHE and others are not. While not a comprehensive list, I’ve outlined some of the most urgent care-relevant changes below. Payers Coverage for COVID-19 Testing, Treatments, and Vaccines During the PHE, federally regulated health plans were mandated to cover COVID-19-related services, often without cost-sharing (ie, patient responsibility). This …
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Denials and rejections are inevitable in medical billing and can have drastic repercussions on the overall profit of an urgent care practice. Studies show almost 30% of medical bills are prone to errors. Avoid these common mistakes to improve the return on your investment. Eligibility Errors Avoidable eligibility errors are the biggest issue in urgent care billing. Over one-third of total visits with a rejection or denial are due to a lack of proper registration and/or eligibility verification. Many clinics utilize real time eligibility (RTE) at a high rate but …
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Heather Real With today’s urgent care operators challenged with increasing expenses and stagnant reimbursements, many thoughtful entrepreneurs turn to ancillary services to drive more revenue into their business. These offerings are numerous and varying in nature. When determining if and what to add to an urgent care business, you’ll need to ask some crucial questions: Is this something that members of your community need and will use? How much capital investment will be required and how much will it add to operating expenses? What is the revenue potential? When weighed …
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Monte Sandler Insurance plans are scrutinizing claims more than ever before. Common questions from our clients are: What does this mean? What should I do? Should I be worried? Generally, there are three types of payer reviews: prepayment, postpayment, and probe. The first step is to figure out what type of review it is. What you do and how you handle the review is dependent on that information. Should you be concerned? Always. Payer reviews need to be taken seriously and addressed properly. The level of concern is different for …
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Heather Real There are many reasons to start your own urgent care, whether it be feeding your entrepreneurial spirit, investing in an industry that has proven to be stable and growing (even amidst multiple economic crises in the last three decades), or responding to the needs of a community. For many, the reasons include at least some of these, and more. Realizing the desire to take on this project is the first step; however, there are many very important tasks that need to be addressed before you can start counting …
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