Practice Management
Connecticut lawmakers apparently think “If at first you don’t succeed…” is the perfect approach to slapping licensing fees on the urgent care industry. Democrats in the state House of Representatives have inserted a provision in the current proposed budget that would require all urgent care centers there to carry a distinct license. The problem (for them) is, they don’t have an abiding definition of what constitutes an urgent care center. Currently, the law views urgent …
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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 …
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The Urgent Care Association vowed to represent the industry’s interests when the Centers for Medicare and Medicaid Services (CMS) released its final rule implementing the Medicare Access and CHIP Reauthorization Act (MACRA) last October. In effect, CMS imposed guidelines for clinicians participating in Medicare’s Quality Payment Program (QPP), and defined two possible pathways: the Merit-Based Payment Incentive Program (MIPS) or the Advanced Alternative Payment Models (APMs). UCA made good on its promise this week by …
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Hospitals and health systems have been taking a hard look at how they can maintain financial stability in recent years. As you’ve read here, many are venturing into urgent care, both on and off campus. Now, some are taking another step toward becoming everyday community health providers by offering, essentially, primary care in their emergency rooms. An article in Modern Healthcare details how one of them, Carolinas Healthcare System, realized the same old way of …
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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 …
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Telemedicine is gaining traction in many walks of medicine, though some providers still may be concerned they don’t know how to get started. In addition, many practices are looking at ways to offer more tests on site. The next wave of smartphone capabilities could be the next step forward in both respects. Researchers at the University of Illinois have developed a device capable of processing samples of blood, saliva, or urine remotely using the light …
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Health system administrators and fans of the Affordable Care Act (ACA, or “Obamacare”) have been lauding the fact that employment in the healthcare industry has been climbing since the ACA was implemented. While that may be factually correct in terms of overall numbers, it is also true that health systems have been cutting jobs strategically in order to cut payroll expenses. Not too long ago, Becker’s Hospital Review identified 48 layoffs that have taken place …
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President Trump recently declared the epidemic of opioid addiction and related deaths to be a national emergency, pledging the federal government would spending more money and pay more attention to stemming the crisis. While details are still to come, theoretically future actions could include mandatory education for prescribers nationally and increasing funds to treatment and prevention programs. Coinciding with that, Express Scripts, the nation’s largest pharmacy benefit manager, is trying to restrict access to opioids. …
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Medically necessary is hard to define to universal approval, with insurers and healthcare professionals often being on opposite sides. Some shady service providers are looking for ways to exploit that divide for their own profit, sometimes leaving urgent care operators at risk for penalties, potentially. Right now, some allergy companies “offer” to help practices initiate allergy testing and immunotherapy services; the company places an employee on site to handle the allergy tests and facilitate immunotherapy—in …
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Medicaid recipients who go to Tennessee emergency rooms with nonemergent complaints cost the state nearly $85 million a year, according to a report published online by WATE television in Knoxville. The data show federally and state-funded nonemergent ED visits drove up costs 25% in 2016 compared with the previous year. Some of the most common complaints that could have been treated in a lower-acuity (and less costly) setting like urgent care included acute upper respiratory …
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