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Six Common Mistakes to Avoid in Urgent Care Billing
by Sheri Poe Bernard, CPC, CPC-H, CPC-P
11/01/2007 Continued from page 4 5. Providing Ancillary Services and DME Many health plans today work with specific laboratories for their beneficiaries. If you are an urgent care center providing these services, it is necessary to have either a CLIA waiver, which in turn limits the number of tests you may perform. If you are using an outside reference laboratory make certain the patient’s insurance will cover services rendered at that lab, especially if they are non-emergent. If you have to send the patient to another site for laboratory services make certain you supply them with a written request for the services you want and a valid diagnosis to support medical necessity.Providing radiographs in an urgent care center can be tricky if the center is owned by a hospital. If the urgent care center is private and free standing, no modifier —26 is required. If the center is owned by a hospital, a modifier —26 is necessary to delineate the professional-only portion of the service. If you are supplying durable medical equipment (DME) you will need to apply for a separate billing number from your regional DME payor. You can’t send these claims to your regular carrier as they most likely will not reimburse for the supplies. You will need a valid HCPCS Level II code for many of these items.
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