Clearing Up the Confusion in COVID-19 Testing

There are so many options available for coronavirus disease 2019 (COVID-19) testing. How do you know what test is best for your urgent care center? The need for virus testing was and still is paramount in the fight against this COVID-19 pandemic. The American Medical Association introduced new Current Procedural Terminology (CPT) code 87635, “Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19)], amplified probe …

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The Myth of ‘Control’ with In-House Billing

We keep our billing in-house so we can control it. I have been in the revenue cycle management (RCM) business for over 25 years and I guess I have heard this quote from people more than a thousand times. Unfortunately, 95% of the time it is just not true! Having your billing staff in the clinic may make you feel better but, in most cases, there is no control at all. It is just a …

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The Impact of Public Health Emergency on Revenue Cycle Management

March and April were challenging months for all of us, and the revenue cycle management arena is no exception. A few months ago, we never would have imagined that our everyday lives would grind to such a halt—from schools, sports, concerts, and events canceled to self-quarantines and stay-in-place mandates. The financial markets have lost tremendous value and many people have lost or will likely lose their jobs. In all of this craze, we have seen …

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Contracting and Credentialing: A Complex Obstacle to Navigate

The terms contracting and credentialing are often used interchangeably, but the processes involved in each, while interdependent, are very different and have different outcomes. Contracting, in brief, is the process of creating a formal legal agreement between the payer (insurance company) and the provider (facility, physician, and/or physician extender). The contract outlines expectations and requirements of all parties. The effective date of the agreement, the reimbursement/fee schedule, place of service, termination clauses, services allowed and …

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Taking Pictures, Dog Paddling, and Apple Picking: A Metaphorical Approach to Healthy Revenue Cycle Management Metrics

You have seen all the articles about benchmarking and standard revenue cycle management metrics. The repetition of these basic articles is nauseating. This is not one of those articles. To illustrate that, let’s start by asking, what do photography, dog paddling, and apple picking have to do with your urgent care billing? Photography Standard RCM metrics are like the settings on your digital camera. Most people set the camera to Program mode (or “P” for …

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Ringing in 2020 with CPT Changes

It’s that time of year again. The American Medical Association has implemented the 2020 Current Procedural Terminology (CPT) code set. This year we have 394 changes: 248 additions, 71 deletions, and 75 revisions. All changes took effect on January 1. While the impact to urgent care is minor, several items bear highlighting Health Behavior Assessment and Intervention The codes in the Health Behavior Assessment and Intervention section are used to report services provided to improve …

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Already Looking Forward to 2021—and (Hopefully) Smoother Sailing with E/M Coding

On November 1, 2019, the Centers for Medicare & Medicaid Services (CMS) confirmed with the final rule for 2020 that they have accepted all of the American Medical Associations (AMA) recommendations for coding of office and outpatient evaluation and management (E/M) services starting in 2021. This will offer some documentation relief for providers who have been held to dated 1995 and 1997 guidelines that were written before the use of electronic medical records. However, these …

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Three Tips to Optimizing Patient Collections

Over the last decade, perhaps the most staggering shift in consumer-based healthcare has been the increase in patient responsibility. Due to the rise in high-deductible health plans (HDHPs), providers are now faced with the challenge of collecting an average of 35% of their revenue from patients, without a downward swing in the insured population. Consider the following: In 2018, 85% of covered workers had a deductible, up from 59% in 2008. The average deductible in …

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Keeping Up with CMS Policies on Medicare Cards and Flu Vaccine Reimbursements

New Medicare Card Transition Period Ends December 31, 2019 As a result of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), in 2018 the Centers for Medicare and Medicaid Services (CMS) began issuing new Medicare cards to all beneficiaries; unlike the previously existing cards, the new cards do not display the beneficiary’s Social Security number. CMS set up a schedule to mail out the new cards based on regions, to be completed by …

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Be Ready for the ICD-10-CM 2020 Updates

October 1, 2019 introduces 273 new diagnosis codes, 21 deactivated codes, and 35 code description revisions to the International Classification of Diseases, 10th Revision, Clinical Modification set, bringing the total ICD-10-CM code count to 72,184. The following describes those that are most relevant to the urgent care provider. Chapter 8: Diseases of the Ear and Mastoid Process (H60-H95) There is just a small change to note here, where code H81.4, “Vertigo of central origin” was …

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