IMPACT OF REVENUE CYCLE MANAGEMENT IN URGENT CARE CENTER

6 THINGS TO REMEMBER DOING BILLING FOR URGENT CARE CENTER

1.      Never Ignore coding in your startup Urgent Care Center

Unique coding issues to your new urgent care center include:

1. When can you append an evaluation and management (E&M) code to a procedure?


2. What modifiers must be added to an E&M code in order to assure payment?


3. How can you successfully appeal when a payer consistently denies payment for the E&M code in this situation?


4. What is the definition of an established vs. a new patient in urgent care? How and when does it differ from a primary care practice?
   With what payers and in what circumstances do the definitions differ?


5. When can you code for a intermediate laceration repair even if you have not performed a layered repair?


6. How do you code for multiple procedures performed on the same visit?


7. When can you get credit for a complete history even though a complete history was not performed?


8. What is the difference between the CMS definition of body areas and organ systems for E/M coding? At hat levels of physical exam do I count body areas, organ systems, or both?

2.      Delaying negotiating managed care contracts for your urgent care clinic

Start Contracting with Insurers Immediately

If you need a concrete example, you may be interested in a 2003 BizJournals article on Night Owl Pediatrics in the San Fransisco Bay area. The paper noted that the owners took some "calculated risks." They decided "not to wrangle with insurance companies [i.e., not to contract with insurers].... [They charged] a flat $100 fee for basic procedures, and [never] more than $200 for more complicated cases such as lacerations that require sedation.... They wanted to focus quality rather than on volume." But, notes BizJournals, the "consumers weren't ready" for this model. Four months after opening the owner is quoted as saying, "Where are all the patients?"

3.      Choosing an inexperienced spouse or a local physician receptionist to do billing for your new urgent care

New Urgent Cares Should Use an Expert Urgent Care Biller

4.      Using primary care billing company to bill for your startup urgent care center

Use a Billing Company with Expertise in Urgent Care Billing

5.      Purchasing inadequate software for use in urgent care

Purchase EMR & Practice Management System Made Specifically for Urgent Care

6.      Ignoring urgent care billing

Urgent Care Billing Experts: Find them or fail!

In order to be successful in urgent care, you must have access to outstanding experts in the seven C’s of urgent care billing:

·         Contract negotiations

·         Credentialing

·         Coding

·         Compliance

·         Claim submission

·         Claim formatting

·         Collections

You are the proud owner of a new business-an urgent care center. If you owned a McDonalds or a Laser Quest franchise, you would have to master the ins-and-outs of pricing, expenses, and credit card billing. The business side of urgent care is coding, billing and collections.

So how do you learn all of the ins and outs of urgent care billing? The answer is simple; you can’t.  You have to focus on business plan, pro forma, floor plan, building codes, signage, marketing, lines of service, patient complaints and a hundred other business items.

BUT you will never succeed, if you fail in the critical aspects of urgent care billing.  So how should you handle billing in your urgent care?

"Make plenty of mistakes; just don't make the big one."