Journal of Urgent Care Medicine

Benefits of Adding Primary Care Services to Your Urgent Care

Phyllis Dobberstein, CPC, CPMA, CPCO, CEMC, CCC In the last few years, the Centers for Medicare & Medicaid Services (CMS) has accelerated its long-term effort to strengthen primary care as the foundation of the U.S. health system. Through new payment models, regulatory changes, and equity-driven initiatives, CMS aims to rebalance healthcare spending toward prevention, care coordination, and whole-person health. All these are areas historically underfunded compared to specialty or hospital care. Major policy changes have …

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 …

What It Costs To Chase Payment

A recent MedCity News survey reveals that providers end up investing about 2-10% of the collection value of their claims on subsequent efforts to chase down payment, scrubbing away at margins and slowing administrative workflows in revenue cycle management. At the same time, 90% of hospital and physician practice respondents say they are at least somewhat interested in artificial intelligence tech tools to make improvements in billing, and about 66% already have experience with such …

Mastering Revenue Cycle Management

Phyllis Dobberstein, CPC, CPMA, CPCO, CEMC, CCC Revenue cycle management (RCM) may not be the most glamorous part of urgent care, but it is one of the most critical. A clinic can provide excellent patient care, yet still struggle to keep its doors open if its billing processes falter. Too often, urgent care leaders rely on assumptions, outdated practices, or incomplete data that lead to financial surprises and lost revenue. Running an effective Revenue Cycle …

Timely Filing: What Every Practice Needs to Know

Nikki Benedict Timely filing is a critical concept in medical billing that directly impacts claim reimbursement. Despite its importance, the specific requirements and terminology can vary across payer contracts, making it essential for billing teams to understand both the general rules and the payer-specific nuances. When reviewing a payer contract, timely filing requirements may be outlined under the following sections: Providers can find Medicare and Medicaid timely filing requirements by consulting Centers for Medicare & …

Credentialing: The Gatekeeper of Access and Reimbursement

Phyllis Dobberstein, CPC, CPMA, CPCO, CEMC, CCC In the healthcare ecosystem, credentialing is more than a bureaucratic hurdle—it’s the linchpin of successful revenue cycle management. For urgent care centers, credentialing determines whether providers can be reimbursed for the care they deliver to insured patients and whether they can participate in insurer networks. Credentialing is the formal process by which payers—commercial insurance companies, Medicare, and Medicaid—verify the qualifications, training, licensure, and work history of care providers. …

Effective Strategies Minimize Claim Denials in Urgent Care

Urgent care centers serve a crucial function in providing prompt and accessible healthcare, but they encounter unique challenges in managing their revenue cycle, particularly in reducing claim denials. Unlike primary care or specialized medical practices, urgent care clinics often treat patients on a one-time basis, making both patient intake and billing more complex. Additionally, frequent turnover among front desk staff contributes to recurring errors in patient registration, insurance verification, and claims processing, all of which …

Refresher: Guidelines for E/M Coding

Phyllis Dobberstein, CPC, CPMA, CPCO, CEMC, CCC Hard to believe that the new evaluation and management (E/M) guidelines have been in place for urgent care for 4 years. These guidelines created by the American Medical Association (AMA) were a complete shift from what was previously published by the Centers for Medicare & Medicaid Services. Instead of bullet points, levels are determined by the work involved in treating a patient. E/M codes can be leveled by …

What’s New in Telemedicine for 2025?

Phyllis Dobberstein, CPC, CPMA, CPCO, CEMC, CCC The American Medical Association (AMA) added a Telemedicine Services category to the Evaluation and Management (E/M) section of the Current Procedural Terminology (CPT) code set. Codes are divided up by the technology used and the patient type (ie, new vs. established). These codes are for synchronous, real-time interactive encounters between the provider and the patient. Codes are leveled by medical decision making (MDM) or time, which is similar …

Look Ahead For RCM Success

We are deep into the fourth quarter of 2024, and you are probably preparing for the holidays and wrapping up year-end projects. As we celebrate the end of the year, it is important to also look ahead and lay the groundwork for revenue cycle management success in 2025. Following are some points to consider in your strategic plan for next year. Contract Renegotiations Understanding your payer agreements and your patient population will be instrumental to …

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