Normal procedures are anything but in the era of COVID-19. So, it’s imperative to ensure that all staff members are aware of the special circumstances surrounding billing for services related to the pandemic. Patients expect (correctly) that they can get vaccinated or tested without incurring any out-of-pocket expenses. Consequently, it came as quite a surprise when a patient in the Norcross, GA area stopped into an urgent care center to be tested for COVID-19—only to …Read More
More Seniors Are Heading to Urgent Care. Be Sure You’re Coding Correctly for Cognitive Assessments
As we’ve told you recently, weeks- (or even months-) long waits for primary care appointments are forcing more patients to consider whether a trip to urgent care for ongoing concerns would be a wiser choice. With senior citizens among them, it would also be wise for you to consider whether you’re on point with optimal coding practices for cognitive assessments—which are required by the Centers for Medicare and Medicaid Services at annual wellness visits for …Read More
It Pays to Get Billing Right the First Time—Ask the Freestanding ER That Billed $50K+ for a COVID-19 Test
With no one being infallible, mistakes are going to happen. While some that occur in the field of medicine have lifelong consequences, most are minor, easily fixed, and soon forgotten. Unless they’re so colossal that they make national headlines, like the case of a Texas man who went to the wrong freestanding emergency room for a test after being exposed to COVID-19 and wound up getting socked with a bill for $56,384. As reported by …Read More
Surprise COVID-19 Bills Are Starting to Hit Patients. Can Urgent Care Be a Solution?
U.S. media reports in the early weeks of the COVID-19 pandemic drove many worried citizens to seek care (or even just testing) wherever they could, without regard to whether it was the best setting for their situation. Months later, as billing is catching up, it’s time to pay the piper—and some of the bills are far higher than patients may have expected. As we’ve seen historically, a good number are associated with freestanding emergency rooms. …Read More
A Novel Virus Demands a Novel Approach to Billing and Coding. Are You Up to Speed?
If COVID-19 has taken frontline clinicians and public health experts by surprise, you can be sure the same is true of billing and coding professionals. JUCM has brought you updates as often as possible (see The Impact of Public Health Emergency on Revenue Cycle Management by Monte Sandler, executive vice president, revenue cycle management for Experity, for example), but as the situation evolves so must your approach. So, Experity and the Urgent Care Association collaborated …Read More
Update: Experity Issues New Guidance on Coding for COVID-19 Services
Our collective understanding of COVID-19 changes several times a day—as do procedures to ensure your urgent care operation receives the proper reimbursement for the indispensable services you provide. Just last week Experity released what was then new information on proper coding procedures; it’s outdated already, so the company has issued an update. Review it on the JUCM website to ensure you’ll be compensated fully and as efficiently as possible.Read More
Updated: Experity Issues Guidance on Optimal Coding for Services Related to COVID-19
COVID-19 has been officially declared a pandemic, and school districts, sporting events, and cultural traditions like St. Patrick’s Day parades are being canceled in order to lower the risk of transmission among large throngs of people. One thing that goes on, however, is the day-to-day operation of the urgent care center—the only difference being that your work is more essential than ever. Secondary to that, of course, is the need to be properly reimbursed for …Read More
What Would Doing Away with ‘Incident-to’ Billing Mean for NPs and PAs—and Urgent Care?
The Medicare Payment Advisory Commission’s unanimous recommendation that Congress do away with “incident-to” billing could have a strong effect on physician assistants and nurse practitioners—and therefore, considering the growing role PAs and NPs play in this setting, on urgent care overall. If incident-to billing is eliminated, PAs and NPs will have to bill independently and at a lower reimbursement rate than they do now. Currently, the services of PAs and NPs who are truly assisting …Read More
Are You Maximizing Claims on Radiology, Pathology, and E/M Services?
Date-of-services rules can be cumbersome on a good day—and can even turn an otherwise good day into a major headache for coders. A Medicare administrator contractor (MAC) put forth a provider outreach and education (POE) recommendation recently aimed at leveling out that “uphill battle” when it comes to complying with date-of-service requirements. An article in published online by DecisionHealth recommends clarifying the specific date-of-service rules your urgent care center follows when reporting common radiology, pathology, …Read More
Independence Blue Cross Slashes Reimbursements on Modifier 25
Independence Blue Cross has implemented a new policy that cuts reimbursements on procedures billed with modifier 25 (“Significant, separately identifiable E/M service”) by half for care given to Medicare Advantage members and patients covered by private insurance plans. The lower rate does not apply to traditional Medicare claims. Independence covers patients under its own name, but also through QCC Insurance Company, Keystone Health Plan Eastand AmeriHealth. The move sets Independence apart from other payers, including …Read More