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Urgent Care Reimbursement

Tierni Posted Wed 30th of November, 2016 13:07:08 PM
We have a provider opening an Urgent Care Facility, and we are trying to assist him with figuring out the billing. What would be the appropriate way to bill his services versus the facility fees? Would we bill everything out with a location code 11 so the reimbursement is higher and he is paid for his overhead, etc... Or, would we bill his services out with a location code 20 (Urgent Care Facility) and then bill out the supplies, etc.. with a UB40??
SuperCoder Answered Thu 01st of December, 2016 14:10:15 PM

our team is working on you query, will get back to you soon.

SuperCoder Answered Thu 01st of December, 2016 14:10:16 PM
our team is working on you query, will get back to you soon.
Tierni Posted Thu 01st of December, 2016 16:02:49 PM
Looking forward to hearing back from you! Appreciate the help
SuperCoder Answered Sun 04th of December, 2016 15:14:36 PM

Hi Tierni,

Since the provider is opening an Urgent Care Facility, it is better to bill services with location 20.

Urgent care billing takes a variety of different forms.

Firstly: 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.

Secondly: 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. 

Thirdly: Some urgent care facilities use global contracts under the billing code S9083. By using this code, urgent care providers receive the same amount of reimbursement for a runny nose as they would for a heart attack or other serious case. “Its just that it makes coding easier because it’s a single code (case rate code), you don’t have to worry about coding all the specific procedures with all the appropriate pending. There’s a convenience factor there, there’s an ease factor, and generally there’s less opportunity for the insurance companies to make mistakes and question your charges as well. So, from a cash flow perspective there’s a benefit. 

Better is to bill as services out with a location code 20 (Urgent Care Facility) and then bill out the supplies to avoid "case rate billing" and also avoid urgent care centers to send higher acuity cases to hospital emergency departments (EDs). Hope it helps. Feel free to ask for further query. 

 

 

SuperCoder Answered Sun 04th of December, 2016 15:14:37 PM
our team is working on you query, will get back to you soon.

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