Journal of Urgent Care Medicine

UCA Webinars: Preparing for the New Medicare Quality Payment Program

Ensuring payers send you every penny you earned can seem like a daunting challenge, especially with new rules—or entire systems—coming out every year. To help you start the new year on the right track, the Urgent Care Association is hosting two webinars on January 11 and 18 to discuss the new Medicare Quality Payment Program. Each one-hour webinar is designed for physicians, physician assistants, nurses/nurse practitioners, coders/billers, and IT staff. The presenter will be Camille …

Urgent Care Centers: Switch to Digital Radiography or Lose Money

Urgent care operators who have adopted digital radiography (DR) will tell you it’s cheaper to maintain, less cumbersome to operate, and overall just more efficient to use than old-school analog x-ray systems. Now you can add Medicare to DR’s proponents—and they’re putting your money where their mouth is. Come 2017, Medicare will start reducing payments for exams performed on analog x-ray systems by 20%. Starting in 2018, urgent care centers using computed radiography (CR) will …

Imaging: X-Rays and Computed Tomography

Q. I understand that there will be reductions for x-ray reimbursements from Medicare in 2017. Is this true? A. To give imaging providers an additional incentive to adopt more advanced x-ray technology, Medicare will reduce reimbursement, beginning in 2017, for the technical component (and the technical component of the global fee) in claims submitted for x-rays performed with analog equipment. The cuts will continue in future years for those using computed radiography equipment (Table 1). …

Vermont Will Try an ‘All-Payer’ System Starting in January

Vermont is going to try following Maryland’s lead by testing an all-payer reimbursement system for healthcare providers in 2017. Where Maryland’s long-held policy covers only hospitals, though, Vermont plans to use an accountable care organization (ACO)-type structure to cover all providers, regardless of setting (including urgent care). All-payer systems require all insurers, whether private, Medicare, or Medicaid, to pay similar rates for services. The goal is to increase the quality of care while decreasing the …

New California Bill Protects Patients from ‘Surprise’ Medical Fees

California residents who have to visit out-of-network medical providers will get much-needed economic protection under a new bill just passed by state legislators. The bipartisan bill, AB72, assures that patients who received care in in-network facilities would have to pay only in-network cost sharing, regardless of whether the provider who treated the patient is in-network or out-of-network. This would not apply to self-insured employer health plans, however, which are shielded from state regulations by the …

Affordable Care Act Giveth to—and Taketh Away from—Urgent Care Centers

William Rodney, MD couldn’t jump fast enough when he found out the Affordable Care Act (ACA, or “Obamacare”) would be raising Medicaid primary care payments to Medicare levels. His urgent care practice (featured here previously; see One Year In, Latino-focused Clinic Doubles in Size) took in enough additional fees to create an outreach clinic for bilingual uninsured patients and to provide x-rays, ultrasound, and other services for underserved communities in Tennessee. Now he’s worried about …

CDC: One Out of Five Visit a U.S. Emergency Room Every Year

New data from the Centers for Disease Control and Prevention reveal that one out of every five Americans visits a hospital emergency room at least once a year, with California, Florida, Illinois, New York, and Texas accounting for more than a third of all ED visits nationally. The report also reconfirms that most of these patients are adults who are not admitted to the hospital. Of interest to urgent care operators, the national rate for …

DOJ Sweep Underscores Need for Toeing the Line in Medicare Practices

Physicians and nurses were charged along with business owners after the Department of Justice moved in on scores of clinics that were allegedly involved in fraudulently collecting fees from Medicare and Medicaid. The DOJ says more than 300 people were charged in healthcare fraud schemes involving $900 million in false billings. Sixty suspects were allegedly linked to schemes involving Medicare Part D, which is the fastest-growing component of Medicare, overall. According to court documents, the …

Will New CMS Program Boost Medicare Quality Bonuses?

The Centers for Medicare and Medicaid Services (CMS) calls it a brand-new platform, while skeptics are saying it’s just the same-old structure with a fresh coat of paint. Either way, CMS is rolling out the Quality Payment Program, which it says will ease documentation requirements for physicians while also providing new opportunities to earn bonuses by providing quality care. Under the program, physicians can receive Medicare reimbursement by participating in either the Merit-Based Incentive Payment …

‘Rampant’ Medicare Overbilling Highlights Need for Cost-Efficient Care

Medicare was overbilled by 12.1% in 2015, thanks to improper fee-for-service reimbursements in 21 states, according to the Centers for Medicare & Medicaid Services (CMS). That’s up from 8.6% just five years ago, making it one of the highest error rates in history. Louisiana was the worst offender, with an overbilling average of 19.4%—equating to over $1.2 billion in excess fees. Texas and Georgia also showed over a billion dollars in overcharges to Medicare last …