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 …
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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 …
Read MoreDeveloping Data: October, 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).
Read MoreDon’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 …
Read MoreDeveloping Data: September, 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). …
Read MoreWorkers’ 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 …
Read MoreBayes’ 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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Psychiatric treatment as an urgent care model
Urgent message: Offering mental health services in an urgent care setting could facilitate treatment for conditions such as depression and help eliminate the stigma associated with psychiatric care. Introduction Consumers value urgent care for its on-demand access to medical treatment without waiting to schedule a doctor’s appointment and for its cost savings over hospital emergency rooms (ERs). While urgent care centers have historically focused on treating coughs, sniffles, cuts, scrapes, sprains and strains, the convenience …
Read MoreDeveloping Data: July/August, 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). A …
Read MoreE/M for Sinusitis and Pharyngitis
Q. The clinic I work at uses 99214 for most patients (50%) for sinusitis and pharyngitis. Is this a common code to use for these problems? A. The E/M levels of services recognize sevencomponents: History Examination Medical decision making Counseling Coordination of care Nature of presenting problem Time The history, examination, and medical decision making are considered to be the key components in selecting a level of E/M service. Counseling, coordination of care, and the …
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