Journal of Urgent Care Medicine

UCA Files Comments on Medicare QPP

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 …

Can Hospitals Find Salvation by Offering Primary Care in the ED?

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 …

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 …

Smartphone Diagnostics Could Make Telemedicine, Lab Testing More Accessible

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 …

Urgent Care Growth is a Good News/Bad News Scenario for Hospitals

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 …

Express Scripts Is on the Same Page with the White House on Opioids

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. …

Watch Out for Shady Allergy Testing—and Billing—Schemes

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 …

Report: Nonemergent ED Visits Cost Tennessee Nearly $85 million a Year

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 …

CMS Ups Its Game in Going After Medicare Fraud

Recent headlines have put Medicare fraud—and the search for those committing it—in the spotlight. However, urgent care clinicians who toe the line in treating Medicare patients are less likely to face unwarranted audits in the future—while fraudsters are putting themselves more at risk than ever—under a new system revealed by the Centers for Medicare and Medicaid Services (CMS). The agency is essentially narrowing the scope of practices it will investigate for fraud, hoping it will …

The Cost of Compliance Continues to Climb—Plan Accordingly

The Merit-Based Incentive Payment System (MIPS), the EHR incentive program, and other Medicare programs are driving the cost of complying with federal regulations through the roof, according to a new survey from the Medical Group Management Association (MGMA). The group says nearly half of practices in the U.S. spend more than $40,000 per full-time physician to keep up—while 14% say that figure is $100,000 or more per physician. The MGMA says the wide range is …

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