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Urgent Care

Lori Posted Thu 25th of August, 2011 17:15:22 PM

Do Immediate Care Clinic (sometimes called Urgent Care), have a different rate of reimbursement for pro fees, and would we also be allowed to bill a facility fee?

SuperCoder Answered Thu 25th of August, 2011 21:47:40 PM

Urgent care centers should make it clear to MCOs that using case-rate coding may force urgent care centers to send higher acuity cases to hospital emergency departments (EDs). Total fees at the ED can run up to 10 times more than the fees for rendering the same services at an urgent care center.
We recommend that, whenever possible, the urgent care center negotiate with the MCO to show that it is in everyone’s best interest to pay for services rendered rather than defaulting to one-size-fits-all reimbursement. Some visits take twenty minutes; others may take more than three hours. If the MCO insists on only paying for twenty minutes worth of work for every visit, then the urgent care provider will need to refer the more resource-consuming cases to other providers in order to avoid financial losses. In the end, this will cost the MCO significantly more than paying the urgent care for services rendered.


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