Wiki Urgent Care Billing - drugs administered

[Davieda Skobel]

We have just started billing for an Urgent Care and I am looking for information on what can be billed and how. I don't want to leave any money on the table. Need info on where to look for rules on billing drugs administered and xray and lab tests. The physician owns all the equipment and purchases the drugs himself. It is a free standing Urgent Care, no hospital affiliation.Any help would be appreciated.

 

[sunchips]

I bill for 2 urgent care offices and the same rules apply as in any practice. There really aren't any "billing rules" except the one's we already follow. There are payers starting to recognize Urgent Cares but there are no separate fee schedules to date that I have seen. Therefore you would use the same CPT codes as you do now. What helped me to learn Urgent Care was utilizing the closest specialty I had in my repertoire. The closest specialties for me (to give you an idea of what to expect) was internal medicine & Family medicine. The reason for this is because those two specialties deal with a large variety of health issues. The biggest difference in dealing with an Urgent Care vs. the aforementioned specialties will be whether or not you can bill for certain services as an Urgent/Emergent provider (and not the actual PCP). For instance, will an HMO pay for a yearly physical in an Urgent Care setting? No. The patient needs to see there PCP. This is considered non emergent. Therefore, you may want to ask the physician who owns the Urgent Care if he is willing to be a PCP for some patients, as you can have this dual role. You just need to make sure the credentialing is right for this. Also, your front desk staff will need someone strong in insurance verification. The reason for this is because your chances of collecting money on a patient account is even more drastically reduced because the chances of that patient coming back for services is less likely. In addition, some of your patients may not have Urgent Care Services as a benefit. Other than that make sure you have the correct Place of service code (20) on your claims and make sure the doctor isn't coding 99215 all the time just because he/she has an Urgent Care. As I mentioned earlier, same coding/billing rules apply. Your operating hours may come into play as well. So, make sure you know the standard hours of operation for an Urgent Care in your area. You may want to consider contacting the Urgent Care Association of America. They may have some more information on upcoming regulations. Their websites is http://www.ucaoa.org/index.php. I hope this helps you...

Best Wishes,
Felicia