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Internal Medicine conversion to urgent care

William Ivan Posted Wed 10th of September, 2014 08:20:13 AM

My physician wants to change his practice from an internal medicine typical practice to an urgent care facility in hopes or thoughts that his reimbursement levels will be higher from insurance companies.

My thoughts and limited research on this is that there is not an increase in reimbursement/RVU's unless the urgent care center is associated with a hospital.

Can you provide me some input on coding and billing for an urgent care facility owned by a sole physician with no affiliation to a University or hospital?

SuperCoder Answered Wed 10th of September, 2014 08:41:13 AM

Thanks for your question. The reimbursement will be dependent upon your commercial insurance contracts. This is where you would need to start to find out what your reimbursement will be and if there will be any difference in rates. The insurance company will normally average your fee schedule based on your locality and what they are reimbursing other "like" specialties in your area. The government insurances such as Medicare, Medicaid, and Tricare would typically be the same since you are still operating as a non-facility practice.

You will also notice that your patients may have a higher copay or deductible for urgent care specialties versus a primary care specialty. You will want to educate your patients on this as they would normally have a lower copay for visits.

The difference in revenue would come from the increased services that the provider may see due to the fact that you would more than likely take walk-ins and acute injuries or illnesses. The provider may see lacerations, dog bites, insect stings, etc as an urgent care practice where you may not have normally seen these types of cases. Hope this helps.

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