Journal of Urgent Care Medicine

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, …

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 …

Be Mindful of Dates of Service When Coding for Flu Shots—or Get Claims Denied

Among the Centers for Medicare and Medicaid Services’ new codes is one that’s likely to be confusing as patients start coming in for flu shots. A quadrivalent vaccine made and distributed by Sequirus is available for reporting, but if billing staff use the corresponding code, 90756 (Influenza virus vaccine, quadrivalent [ccIIV4], derived from cell cultures, subunit, antibiotic free, 0.5mL dosage, for intramuscular use) before January 1, 2018, the claim will be denied. Instead, they’re advised …

When Coding, Remember: ‘Necessity’ Is in the Eye of the Beholder

Providers are employing evaluation and management (E/M) code 99214 more than ever—and seeing fewer denials and higher reimbursements than in the past, ultimately. That doesn’t mean it’s open season on the higher level code (and associated higher reimbursements), however; documenting medical necessity sufficiently is still critical to ensuring the code is valid compared with the reigning most common code (99213). Operators must ensure coders understand that while a level 3 visit requires one to three …

ICD-10 Update: Transition Hysteria Much Ado About Nothing for Most

Much like concerns that the Y2K crossover would wreak havoc on civilization as we know it, the transition to ICD-10 codes has been far less disruptive than was feared by many. A new survey by KPMG shows that 79 percent of organizations have made the transition without any major hiccups, with 28 percent calling it “smooth” and 51 percent reporting “a few technical issues, but overall successful.” Just 11 percent called their transition experience a …

October 1: Out with ICD-9, in with ICD-10

“Urgent care” was in its infancy and electronic medical records were practically the stuff of science fiction when the ICD-9 codes were released in 1979. The Centers for Medicare and Medicaid Services (CMS) takes one giant leap toward catching up with the launch of ICD-10 codes on October 1. As of that date, ICD-9 codes will no longer be accepted. CMS has said the new coding set is expected to “advance public health research and …

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