Beginning April 1, 2019 UnitedHealthcare will revise their policies to discontinue reimbursement for HCPCS code S9083, “Global fee urgent care centers” in some states (see Table 1). The change affects UnitedHealthcare commercial plans, United Healthcare Oxford, and UnitedHealthcare Community Plan policies. Additionally, UnitedHealthcare Community Plan will no longer reimburse HCPCS code S9088, “Services provided in an urgent care center.” Providers should report the Evaluation and Management (E/M), and/or procedure code(s) that specifically describes the services …
Read MoreNavigating the Credentialing Process to Maximize Revenue and Minimize Denials
What is the best way to get my practitioners credentialed with various insurance companies and networks? It is frustrating to try and navigate this convoluted process. I am asked by each insurance company to complete a mound of paperwork and collect a stack of supporting documents for each practitioner. Then I wait months for approval notifications and effective dates. As a result, we end up losing some patients because they want to be treated at …
Read MoreBig Changes in Medicare Evaluation and Management Reimbursement
The Centers for Medicare and Medicaid Services (CMS) has published the proposed changes for the Calendar Year (CY) 2019 Physician Fee Schedule (PFS).1 Probably the most controversial of these proposed changes is the Patients Over Paperwork initiative, which streamlines documentation requirements and reimbursement for Evaluation and Management (E/M) services in the office and outpatient setting, affecting Current Procedural Terminology (CPT) codes 99201 through 99215. CMS has announced that it plans to eliminate differential payments for …
Read MoreSmall Errors Could Cost Big Bucks When Billing for I&D
Q: While reviewing charts where incision and drainage (I&D) procedures were being performed, I came across instances where Current Procedural Terminology (CPT) code 10060, “Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); simple or single” was billed for treatment of an abscess on the finger. I believe this is an error, since this procedure involved an abscess of the finger pad and not just paronychia. Can …
Read More2019 International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) Codes
October 1, 2018 will bring 279 new codes to ICD-10-CM. Combined with 51 deactivated codes (and 143 revised codes), that brings the total number of ICD-10-CM codes to 71,932. We identified a few examples that are especially important for urgent care coders to be aware of; a complete list of ICD-10-CM changes can be found on the CMS website at https://www.cms.gov/Medicare/Coding/ICD10/2019-ICD-10-CM.html. Chapter 2: Neoplasms (C00-D49) Melanoma and other malignant neoplasms of the skin The …
Read MoreClarifying the Coding for Splint and Cast Application by Nonphysicians
Q: I would like clarification on an article I read in The Journal of Urgent Care Medicine (JUCM) online archive. The article, Splint and Cast Application Performed by Someone Other than Physician, referenced that nonphysician staff could bill for splint and cast application. Will you please expand on the references and confirm that we can bill for splint and cast application if it is done by someone on staff other than the physician? A: Yes, …
Read MoreNew Medicare Cards
Q: The Centers for Medicare and Medicaid Services (CMS) started issuing new Medicare cards to beneficiaries in April of this year. What do I need to know about these changes to limit disruption to my patients and medical practice? A: CMS is required to issue new Medicare cards as a part of the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, which mandates that CMS remove Social Security Numbers (SSN) from all Medicare cards …
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Reduction in Reimbursements for Modifier -25
Q: Last fall, Anthem Blue Cross Blue Shield sent a notice to physicians in several states regarding their intent to reduce reimbursement rates on any evaluation and management (E/M) services billed with modifier -25, “significant, separately identifiable E/M,” by 50% effective January 1, 2018. What are the implications for urgent care? A: This announcement initially spurred action from the California Medical Association (CMA) to coordinate with the American Medical Association (AMA), as well as other …
Read MoreThe Incidentals of ‘Incident-to’ Billing
Q: I plan to hire physician assistants and other nonphysician providers in my urgent care clinic. I understand that I can use “incident to” billing to have their patient visits reimbursed at the physician rate. What are the rules for “incident-to” billing? A: The Centers for Medicare and Medicaid Services (CMS) defines “incident to” as “those services that are furnished incident to physician professional services in the physician’s office (whether located in a separate office …
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Turning Patient Accounts Over to a Collection Agency—the Right Way
Q: Should patient accounts ever get turned over to a collection agency? A: The altruistic nature of running an urgent care center—to serve the public—can make it difficult to send patient accounts to collection, but it must be done if you want your center to survive. Some urgent care centers choose to leave patient balances in their billing systems indefinitely, but this puts a serious burden on the business by creating additional statement costs, wreaking …
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