Credentialing and Contracting: What to Expect When Expanding

For those trying to grow their urgent care business, conversations around payer contracting and credentialing (CC) can often be overwhelming and seem contradictory to the mission of On-Demand Care. Tammy Mallow, our resident Experity advisor on all things CC says she often finds herself being the perceived as a “dream killer” when educating owners to the inner workings of this process. Established groups often expect the payer rules to be the same as they were years ago, only to find they may not be able to add a new location …
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Last Minute Coding Changes for 2021

December brought us some last-minute coding changes. In some cases, this caused a small claim delay as clearinghouses and payers scrambled to update their systems. New ICD-10 Codes for COVID-19 Effective January 1, 2021, there are new ICD-10 codes for reporting COVID-19 related diagnoses. These codes replace the existing codes we are using that are not as specific. There are two other new codes: 81 (Multisystem inflammatory syndrome (MIS)); and 89 (Other specified systemic involvement of connective tissue). For patients diagnosed with (MIS) and COVID-19, report U07.1 with M35.81 as …
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FAQ: New E/M Guidelines

It’s 2021, and the new E/M guidelines for office visit codes are here. Hopefully, providers will feel some relief in the amount they need to document and can spend more time treating their patients. This month I’ll answer some of the questions I’ve received. Q. Do all three elements of medical decision-making (MDM) need to be at the same level for the code selected? A. No. Only the two highest elements need to be met for code selection. If the problem addressed is moderate, the data are straightforward, and the …
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What’s New for RCM? Updates on Coding for COVID-19 Testing

As lab testing for COVID-19 continues to evolve, new products—and new CPT codes—continue to emerge. The latest tests combine COVID-19 testing with a test for influenza A and B. There are two types: one includes the polymerase chain reaction (PCR) test, the other includes the antigen test. The new CPT codes are: 87636  Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) and influenza virus types A and B, multiplex amplified probe techniqueThis CPT is effective as of October 6, …
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Looking Forward to 2021

2020 has been a rough year for all of us, and everybody is eagerly awaiting 2021. One thing for urgent care providers to look forward to is simplified documentation standards for evaluation and management guidelines. Current documentation guidelines are over 20 years old. A lot has changed in that time, most importantly the adoption of electronic medical records (EMR). Thus, outdated expectations have created “note bloat,” unnecessary work, and contributed to provider burn out.The first major change that should save providers the most time is that only a “medically appropriate” …
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