Journal of Urgent Care Medicine

The Role of Urgent Care in an Integrated Care Delivery System: Insights from Kaiser Permanente

Urgent message: As the Affordable Care Act encourages greater integration of health insurers, hospitals, and physicians, urgent care will play an important role in increasing patient access, improving clinical outcomes and reducing health care costs. ALAN A. AYERS, MBA, MAcc, Experity Hospitals across the country are partnering with doctors and health insurers—linked by an electronic health record (EHR)—to form accountable care organizations (ACOs) as a way to control health care expenditures by coordinating patient care. …

Developing Data: November, 2014

These data from the 2012 Urgent Care Industry Benchmarking Study are based on a sample of 1,732 urgent care centers; 95.2% of the respondents were UCA members. Among other criteria, the study was limited to centers that have a licensed provider onsite at all times; have two or more exam rooms; typically are open 7 days/week, 4 hours/day, at least 3,000 hours/year; and treat patients of all ages (unless specifically a pediatric urgent care). In …

Workers’ Compensation Visits, Cerumen Removal

Q. I have a question on coding Workers’ Compensation claims. I work in a hospital system and hospital coders oversee our charts. I feel they under code for the work we do. They are afraid of audits and refusal to pay. Typically, they will return the chart so that I can document my time and then they will charge for the time spent instead of the documentation. I’m told there are no “bullet points” or …

New CMS Modifiers, Urgent Care Codes, Supply Codes

Q. What will be the impact of use of the new HCPCS modifiers related to modifier -59 beginning January 1, 2015? A. CMS recently announced the creation of four new HCPCS modifiers that will further refine modifier -59, “Distinct procedural service.” According to CMS, modifier -59 is the most widely used modifier, and it is being used inappropriately in most cases. Adding modifier -59 indicates that a code represents a service that is separate and …

Head in the Game: Cultivating the Mindset of a Successful Urgent Care Operator

Urgent message: Just because you build it, patients won’t necessarily come. As entrepreneurs, successful urgent care center owners must market their services to the community, innovate with new services to fill excess capacity, and create positive patient experiences that spur repeat visits and positive word-of-mouth. ALAN A. AYERS, MBA, MAcc Practice Velocity One needn’t look further than the 20,000+ physicians already practicing in urgent care centers nationwide to grasp just how attractive this business model …

Developing Data: October, 2014

Don’t Drink the Kool-Aid

John Shufeldt, MD, JD, MBA, FACEP I did and not just a little. I guzzled the entire Jim Jones carafe full of it. I was an early electronic health record (EHR) adopter and I loved it! In fact, I still do; however, as with any Kool-Aid (particularly when it’s served in Guyana), you can’t just guzzle it and hope for the best. You have to know what is in it or else it can bite …

Developing Data: September, 2014

Workers’ Compensation, Medicare and S Codes

Q. The following example is a common occurrence in our urgent care center when billing workers compensation (WC) claims: Patient A comes to the urgent care center for treatment of injuries sustained while on the job with Employer B. Patient A says, “My boss sent me here because it was close.” Now, Patient A has no insurance, no claim number, and no authorization for treatment, just his employer’s name and a supervisor’s name. Who is …

Bayes’ Theorem and Urgent Care Medicine: Why it Matters

John Shufeldt, MD, JD, MBA, FACEP How many times have you encountered a patient who presents with an issue and tells you about a previously diagnosed condition with which he or she is having ongoing symptoms? It happens to me nearly every shift. A 35-year-old male presents with chronic back pain. He has been to your urgent care center a number of times in the past and presents again with a variation of the same …

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