Be 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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New Data Show Urgent Care Outpacing Retail and ED Traffic

Urgent care started as something akin to the California Gold Rush; if a physician had the resources, the inclination, and the chutzpah to do so, they could stake a claim in the great wilderness of this new way of practicing medicine. The more reticent (some would have said prudent at the time) stayed in their lanes to continue practicing traditional family medicine, or pediatrics, or take shifts in the emergency room. Competition was scarce. That …

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Correct Modifiers Make All the Difference When Coding for X-ray Services

Q: During a recent internal audit of claims where x-rays were being billed, it was brought to my attention that we were not using the appropriate modifiers since we use computed radiography (CR) x-ray machines. What are those modifiers and will using them affect my reimbursement? A: As outlined in the Consolidated Appropriation Act of 2016, the Centers for Medicare and Medicaid Services (CMS) imposed reimbursement cuts to the technical component for x-rays performed on …

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What Exactly Are Whistleblower Lawsuits—and How Can You Protect Your Urgent Care Operation?

Urgent message: The increasingly visibility of “whistleblower cases,” in which employees share in any fines from reporting their employer’s malfeasance to federal and state authorities, calls for urgent care center owners to understand the False Claims Act and the whistleblower lawsuit process. Alan A. Ayers, MBA, MAcc is Chief Executive Officer of Velocity Urgent Care and is Practice Management Editor of The Journal of Urgent Care Medicine. A “whistleblower” is an employee who makes complaints …

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Perfecting the Consumer Financial Experience in Your Urgent Care Center

Perfecting the Consumer Financial Experience in Your Urgent Care Center

Urgent message: Changes to insurance plan design are resulting in increased financial exposure for patients, with urgent care providers scrambling to adapt to the associated rise in patient consumerism. It therefore behooves the urgent care provider to evolve their financial systems and policies such that they align with emerging point-of-sale best practices in order to meet patient expectations, enhance the revenue cycle, and cultivate patient loyalty. Alan A. Ayers, MBA, MAcc is Chief Executive Officer …

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Does Your Website Show Patients How Much Financial Flexibility You Offer?

This month’s Practice Management feature article, Perfecting the Consumer Financial Experience in Your Urgent Care Center, reveals that with increasing flexibility in accessing healthcare, patients also want more flexibility when it comes to paying their bill. Their insurance status comes into play, as do methods of payment. It’s been suggested that such details may even play a part in choosing where they go when they need to see a provider. As such, it could be …

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What is the Liability for an Urgent Care Slandering a Competitor on Social Media?

Urgent message: While competition for patients among urgent care operators can be intense, speaking negatively of a competitor online can lead to unwanted liability. Alan A. Ayers, MBA, MAcc Competition between businesses can be intense. In some instances, comparisons between one company and another can lead to disparaging and inaccurate claims. This can result in unneeded liability for an urgent care owner. Here, we examine how the law of defamation in social media applies to …

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End Users and Consolidators: The Next Possible Wave of Transactions in Urgent Care

End Users and Consolidators: The Next Possible Wave of Transactions in Urgent Care

Urgent message: The idea of a “typical” urgent care operation buyer is evolving along with the industry. While private equity has been an essential player in market growth, healthcare organizations with longer-term vision are now more commonly involved in acquisitions. Corey Palasota, CFA and Emily Schmidt, CFA It’s no secret private equity (PE) has a played a paramount role in the design, development, and growth of the urgent care industry. Collectively, these firms have invested …

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UnitedHealthcare Discontinuing S9083 and S9088 in Multiple States and Medicare Telehealth Policies

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 …

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Proof: Availability of Urgent Care Lowers ED Traffic—and Could Save Up to $1 Billion

It has always seemed self-evident that urgent care centers, offering a lower-cost and usually faster experience that is also on par clinically for nonemergent complaints, should help draw patients away from overcrowded emergency rooms. Just as obviously, that would mean more efficient use of the ED for patients who truly need to be there, and less of a financial burden on the healthcare system. One problem has been a lack of conclusive data to back …

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