Already Looking Forward to 2021—and (Hopefully) Smoother Sailing with E/M Coding

On November 1, 2019, the Centers for Medicare & Medicaid Services (CMS) confirmed with the final rule for 2020 that they have accepted all of the American Medical Associations (AMA) recommendations for coding of office and outpatient evaluation and management (E/M) services starting in 2021. This will offer some documentation relief for providers who have been held to dated 1995 and 1997 guidelines that were written before the use of electronic medical records. However, these guidelines should still be used for any code sets that require them outside of CPTs …
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Three Tips to Optimizing Patient Collections

Over the last decade, perhaps the most staggering shift in consumer-based healthcare has been the increase in patient responsibility. Due to the rise in high-deductible health plans (HDHPs), providers are now faced with the challenge of collecting an average of 35% of their revenue from patients, without a downward swing in the insured population. Consider the following: In 2018, 85% of covered workers had a deductible, up from 59% in 2008. The average deductible in 2018 was $1,573, up 114% from $735 in 2008. Since 2013, the burden on patients …
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Keeping Up with CMS Policies on Medicare Cards and Flu Vaccine Reimbursements

New Medicare Card Transition Period Ends December 31, 2019 As a result of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), in 2018 the Centers for Medicare and Medicaid Services (CMS) began issuing new Medicare cards to all beneficiaries; unlike the previously existing cards, the new cards do not display the beneficiary’s Social Security number. CMS set up a schedule to mail out the new cards based on regions, to be completed by April 2019. The project is now complete and all Medicare beneficiaries should have received their …
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Be Ready for the ICD-10-CM 2020 Updates

October 1, 2019 introduces 273 new diagnosis codes, 21 deactivated codes, and 35 code description revisions to the International Classification of Diseases, 10th Revision, Clinical Modification set, bringing the total ICD-10-CM code count to 72,184. The following describes those that are most relevant to the urgent care provider. Chapter 8: Diseases of the Ear and Mastoid Process (H60-H95) There is just a small change to note here, where code H81.4, “Vertigo of central origin” was added to replace expired codes H81.41, H81.42, H81.43, and H81.49. This change removes the laterality …
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Utilizing Credit Card Pre-authorization to Optimize Revenue

With the continued rise of the cost of healthcare and higher out-of-pocket costs to the patient, urgent care centers are finding more patients struggling to pay their deductible. The process of billing patients for deductibles and other patient responsibility can be a long, drawn out procedure resulting in significant costs, delays, write-offs and slower collection time for the urgent care center. The traditional method of sending out patient statements and waiting and hoping for patients to pay is costly and inefficient. Contacting insurance companies prior to the patient visit to …
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