Wiki Urgent care billing-our practice

[mduncan]

I'm trying to find out if billing as urgent care is worth it to our practice. I would hate to charge our patients a higher copay to get the same reimbursement. We regularly bill a pos 11 however we have everything necessary to bill as pos 20 (radiology, labs, extended hours, etc.) Does anybody know if pos 20 pays at a higher fee schedule? Also, do you have an approximate reimbursement rate for S9088? (I know S9088 isn't billable to Medicare/Medicaid and rates can vary by payor and location)

Thanks

 

[Miller913]

We billed the S9088 code to BCBS (Michigan) as a zero dollar charge. That was their code to say services were provided in an Urgent Care setting because they did not recognize the POS 20, they convert it in their system to regular office visit. We were also told by BCBSM that you had to be open specific hours to be considered & certified as an Urgent Care. The reimbursement from the insurance was the same for an office visit but the patients plan may have a higher co-pay for Urgent care than an Office visit. Hope this helps a little.

 

[GaPeach77]

In addition to an e/m office visit code you can also use the e/m code for extended hours and weekend hours for more reimbursement for a practice.