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 MoreTelemedicine in Urgent Care—Yay, Nay, or Too Soon to Say?
If you read this month’s Urgent Perspectives column (page 1), you were treated to a dynamic conversation between two urgent care leaders about the relative merits—and potential drawbacks—of utilizing telemedicine in the urgent care setting. The disparate opinions presented there are reflected in the larger urgent care marketplace, as well. The Urgent Care Association’s 2018 Benchmarking Report notes an interesting dichotomy: Only 1.58% of the sampling reflected in the report say they provide telemedicine—a drop …
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 MoreHow Best to Manage an ‘At-Will’ Termination
Urgent message: In most states, employment is at will—meaning that an employer can fire or terminate an employee at any time, for any reason that is not against the law. Even so, the employment at-will doctrine isn’t a license for an employer to fire employees at the drop of a hat. There are still critical considerations for urgent care operators to heed when terminating a provider or staff member. Alan A. Ayers, MBA, MAcc is …
Read More
Are Those Teambuilding Activities Really Worth It?
Urgent message: High-profile teambuilding extravaganzas may get your crew pumped up—once or twice a year, and assuming you can shut down your operation for the day. In the 7-day-a-week culture of urgent care, however, you may get better results by making it a day-to-day commitment. Amy Lafko, MSPT, MBA What you will find in this article? ROI of teambuilding Assess the current state of your team Tools to foster teamwork in a sustainable way There …
Read More
Practical Considerations for Buying/Selling Your Urgent Care Practice
Urgent message: As urgent care remains a hotbed of merger, acquisition, and transactional activity, owners and operators may see a prime opportunity to sell their practices at maximum market value. The complexities of selling (or buying) an urgent care practice can make it a daunting undertaking, however, and thus requires careful planning, expert counsel, and due diligence to pull off successfully. Alan A. Ayers, MBA, MAcc is Chief Executive Officer of Velocity Urgent Care and …
Read MoreDo Nurse Practitioners and Physician Assistants Qualify for Overtime in the Urgent Care Setting?
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. Urgent message: Physician assistants and nurse practitioners perform many of the same tasks as physicians in urgent care settings, but ambiguity as to the nature of their practice means additional consideration must be given in how their pay is structured. The federal Fair Labor Standards Act1 (FLSA) states that all …
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, …
Read MoreNew 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 …
Read MoreCorrect 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 …
Read More