Payers

The last time Anthem made big news relevant to the urgent care community, it was something of a blessing: the insurer announced it was going to deny claims for emergency room visits that wound up being for nonemergent complaints, possibly incentivizing patients to go to urgent care instead. The reception might not be so warm for the company’s latest initiative, though. Anthem says it’s going to launch a new app that will allow its members …

Urgent care centers offer convenience and quality care that patients need, at a cost that insurers should appreciate (especially when the alternative would be an emergency room bill). You know this, but sometimes it may seem like private and public payers alike don’t have a clue. The Urgent Care Association has put together a rationale to drive these points home in a position statement aptly titled Urgent Care Centers Deserve Fair Reimbursement for the Services …

State support for reimbursing telemedicine providers is growing at a fast and furious pace—as is consumer adoption of telemedicine services. According to the American Telemedicine Association’s 2019 State of the States Report: Coverage and Reimbursement, 40 states and the District of Columbia have adopted substantive policies or received awards to expand telehealth coverage and reimbursement—just since 2017. In doing so, they’re also increasing access for patients and incentivizing providers (including urgent care operators) to jump …

The U.S. Department of Veterans Affairs will start loosening the rules around allowing individuals covered by VA health plans to visit urgent care centers next week—fittingly enough on June 6, the 75th anniversary of D-Day. The move marks the latest step in the evolution of the Veterans Choice Act, which was adopted 5 years ago in response to complaints that veterans were not able to get timely appointments at VA hospitals. At the time, there …

The United States Department of Health and Human Services is working on a pilot program that would give ambulance operators the option—aided by incentives—to take patients with nonemergent complaints to lower-cost setting like urgent care instead of the emergency room. While the aim is to reduce Medicare and Medicaid costs, patients would benefit from getting in and out of a healthcare facility in less time, with less exposure to whatever brought other patients to the …

A bipartisan collective of legislators wants to put forth a bill in Congress to streamline the prior authorization process in order to facilitate faster, lower-cost care. Since those are the same key attributes that continue to fuel the growth of urgent care, on the surface it might sound like the bill could boost our industry. Not so fast. According to congressional staff working behind the scenes, as quoted in an article published by MedPage Today, …

The terms annual wellness exam and annual physical may cover some of the same territory, but thinking they’re one and the same could be a costly mistake for your patient (which, of course, would be a second-hand costly mistake for you if that irate patient chooses to stop visiting your facility when they need same-day care or starts badmouthing you to their friends and family). This may be an especially complicated issue in urgent care. …

Picture a Medicare patient who needs to see a provider today. It’s not an emergency, but they can’t wait until next Monday, when their primary care doc can squeeze them in. The solution is easy: urgent care, right? The only wrinkle is, they don’t drive anymore. So, they call an ambulance whose only option is to deliver them to the ED even thought their complaint is nonemergent. They wait for hours as the cost mounts. …

As many as 2.1 million United States veterans will be able drop into any approved urgent care center that’s convenient to them whenever they need to, without prior authorization, under new regulations proposed by the Department of Veterans Affairs this week. The option to see private physicians, including urgent care providers, would apply to any vets who would have to wait more than 20 days or who would have to drive 30 minutes or more …

The Centers for Medicare and Medicaid Services has completed mailing new cards to the 61 million people covered by Medicare in the U.S., each with their own unique, randomly assigned Medicare Beneficiary Identifier (MBI). The old cards were based on each person’s Social Security number, the widespread access to which left individuals open to identity theft. When the plan was rolled out to the public last April, CMS said it would take a year for …