Journal of Urgent Care Medicine

Billing Integrity in Urgent Care: How to Manage Risk

Phyllis Dobberstein, CPC, CPMA, CPCO, CEMC, CCC, is Revenue Integrity Manager at Experity. The financial and reputational health of an urgent care practice depends on one simple principle: Bill accurately and compliantly. Yet as reimbursement rules evolve and staffing models shift toward greater reliance on non-physician practitioners (NPPs), many centers find themselves at risk for costly missteps. From billing under the wrong provider to out-of-network (OON) complications and False Claims Act (FCA) violations, administrators are …

Want to Drive Flu Shot Compliance for Your Providers? Demand It!

Despite longstanding advice that people over the age of 6 months should be vaccinated against influenza, more than half of healthcare professionals (HCPs) opt out unless they’re required to get a shot by their employers, according to the Centers for Disease Control and Prevention. More than 75% of HCPs got a flu shot in preparation for the 2016-2017 flu season—but in clinics and other settings where vaccination was not “required, promoted, or offered on site,” …

The Cost of Compliance Continues to Climb—Plan Accordingly

The Merit-Based Incentive Payment System (MIPS), the EHR incentive program, and other Medicare programs are driving the cost of complying with federal regulations through the roof, according to a new survey from the Medical Group Management Association (MGMA). The group says nearly half of practices in the U.S. spend more than $40,000 per full-time physician to keep up—while 14% say that figure is $100,000 or more per physician. The MGMA says the wide range is …

October 2016

Free Urgent Care Webinar: Even a First-Round Draft Pick is an Employee

Providers are the key personnel in any medical facility, and urgent care centers are no exception. To use a sports analogy, they’re the “superstars” of the team—which means they have to deliver if you’re going to have a winning record. However, as independent contractors, they can also put you on the losing side of Department of Labor and Internal Revenue Service violations. Attorney and experienced compliance officer Kurt Tullar will explain how to stay in …

How to Recognize and Handle Potentially Litigious Patients

Angela T. Burnette, JD Urgent message: Although any urgent care center could potentially face litigation at any time, the risks of being sued can be reduced by focusing on provider behaviors that build strong relationships with patients, by recognizing patient behaviors that may increase the odds of litigation, and by having a plan for handling dissatisfied patients. Lawsuits do not discriminate. They are filed against all types of health-care providers—new or experienced, group practice or …

Protecting Patient Privacy in the Cloud

K Royal, JD, CIPP/E, CIPP/US Urgent message: The shift in medical practice from written charts to integrated digital platforms has dramatically increased the visibility, size, and magnitude of health-care information breaches. There are specific steps urgent care operators should take with vendors to protect patient information in this new technological environment. The news makes it seem that data breaches occur on a fairly regular basis. The Ponemon Institute even named 2014 as the year of …

Identifying Risks and Finding Shelter in an Urgent Care Compliance Program

Urgent message: The escalating pressure on the industry to decrease health care costs has resulted in an increase in audit activity from government and private payors for everything from billing and coding to HIPAA and kickbacks. Therefore, it’s more important than ever for urgent care centers to build a culture of compliance. DAMARIS L. MEDINA The health care industry is in the throes of a dynamic regulatory enforcement climate. Federal and state regulators and third-party …

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