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 …
Read MoreRinging 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 …
Read MoreAlready 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 …
Read MoreThree 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 …
Read MoreKeeping 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 …
Read MoreBe 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 …
Read MoreUtilizing Credit Card Pre-authorization to Optimize Revenue
With the continued rise of the cost of healthcare and higher out-of-pocket costs to the patient, urgent care centers are finding more patients struggling to pay their deductible. The process of billing patients for deductibles and other patient responsibility can be a long, drawn out procedure resulting in significant costs, delays, write-offs and slower collection time for the urgent care center. The traditional method of sending out patient statements and waiting and hoping for patients …
Read MoreOptimize Revenue with Improved Claims Denials Management
No matter how diligent your billing staff is about billing charges out correctly, it is inevitable that you will receive claim denials from payers, whether they are justified or not. A claim denial means that no payment is being received for the service, and unless you have someone (or technology) analyze the denial to determine if the denial is appropriate or not, you will not receive payment for the service(s) rendered . Denials come in …
Read MoreGet Ready for the Next Round of Changes to E/M Guidelines
The American Medical Association has announced it is taking the first steps towards revising the new Evaluation and Management (E/M) guidelines that the Centers for Medicare and Medicaid Services (CMS) introduced last year to reduce the administrative burden on clinicians with the Patients over Paperwork initiative.1 Effective as early as January 1, 2021, office visit Level 1 E/M code 99201 will be deleted. Additionally, while the history and exam will be required to be reviewed …
Read MoreBe Aware: The CCI Edits, They Are a Changin’
The Centers for Medicare and Medicaid Services announce an update to claim adjudication rules for National Correct Coding Initiative Procedure-to-Procedure edits to allow bypass of an edit if modifiers 59, XE, XS, XP, or SU are appended to either the column one or column two code. In 2015, the Centers for Medicare and Medicaid Services (CMS) introduced the following modifiers, referred to as X{EPSU} and intended to provide more information in scenarios where modifier -59, …
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