letters to the editor

Dear Editor:

Your new magazine is a welcome addition to our world of urgent care. It provides a lot of insightful information, and your Web site’s information and updated news is a great resource.

I do have a comment regarding an article from your recent issue, “Six Common Mistakes to Avoid in Urgent Care Billing,” by Sheri Poe Bernard. The author states “Also remember, if you provide extended hours as an urgent care center and take patients without an appointment, then it would be inappropriate to add codes from the after-hours services (99050-99060) series of CPT codes.”

Many of us in urgent care will frequently, and legitimately, use 99051, for “service(s) provided in the office during regularly scheduled evening, weekend, or holiday office hours.” Of course we cannot use 99050 because there are never days when we are closed. Just because we offer extended hours, does not mean that we cannot, or should not, use those that code.

Additionally, there are times when 99058 is used, i.e., when you provide services on an emergency basis in the office that disrupt other scheduled office services. Even in urgent care this may occur, usually when someone presents with chest pain, respiratory difficulty, or uncontrolled bleeding. In these situations, proper ICD-9 coding and/or supplemental documentation is necessary.

I just thought I would comment on this discrepancy as seen in common urgent care thought. If we are wrong, please have the author cite a reference from the AMA or CMS providing validation.

Dheeraj Taranath, DO, MBA, MS
Medical director
Premier Immediate Medical Care

Editor’s note: Sheri Poe Bernard provided the following response:

You are correct that some payers reimburse urgent care centers for after-hour services represented in CPT range 99050- 99060. My statement that “it would be inappropriate” to report codes 99050-99060 in an urgent care setting was too broad and not reflective of the entire healthcare marketplace. I appreciate you bringing this to my attention. Codes 99050-99060 were revised or created in 2006, and 2006 CPT Changes: An Insider’s View states that the codes are: “Intended to be reported in addition to the service provided as indicated in their descriptor. The revisions and additions are intended to describe as many as possible of the combinations in which a service is provided outside of the usual time frame and location in order to allow a wider use of these codes.”

The “location” in codes 99050-99060, except 99053 and 99060, specify “in the office.” While 2006 CPT Changes stresses that location is one key to appropriate use of these codes, it doesn’t answer the question of whether an urgent care facility qualifies as an “office.” However, the CMS Place of Service code for urgent care facilities excludes offices, as its definition reads: “Location, distinct from a hospital emergency room, an office, or a clinic, whose purpose is to diagnose and treat illness or injury for unscheduled, ambulatory patients seeking immediate medical attention.”

This citation can be found at http://www.cms.hhs.gov/transmittals/downloads/R1366CP.pdf  

Dear Editor:

In your recent article, “Pain Management for Billing and Collection Systems,” Ross Ose further discusses the link between a clinic’s success and their billing and collection process. He begins by raising the key question every clinic must address: conducting billing and collections internally versus externally. Based upon my experience, I agree with his recommendation of outsourcing this activity when it becomes unmanageable, typically at startup and when the practice patient volumes have grown to a significant size.

Mr. Ose goes on to ask the question about the merits of an Internet-based versus in-house software solution and recommends implementing an Internet-based or ASP solution. Data back-up, working remotely and upgrade management are listed as key benefits of an Internet-based solution. He also suggests that a lack of back-ups, training, hardware redundancy, plus more downtime and system maintenance are the key problems of a client/server solution. This Internet-based versus in-house (or client/server) software solution debate is not new. There has been a great deal of discussion and debate regarding the pros and cons of both approaches. Based on these debates and my experience, I cannot support Mr. Ose’s conclusion. The key benefits he associates with an Internet-based solution are also available with some client/server solutions. There are client/server solutions that offer automatic, overnight upgrades and robust data back-up schemes that include redundant off-site storage of data. In addition, an in-house server can be accessed from anywhere using virtual private network (VPN) technology. With regard to hardware, there are hardware components in both the ASP and client/server environments, and both require maintenance, software/security patches, upgrades, etc. An in-house solution helps to ensure that the clinic maintains control over their patient and financial data and eliminates the dependency on an Internet connection. The key here is to have a solution provider that takes a partnership approach to supplying and supporting the software and hardware long term. Similarly, every solution provider — regardless of underlying technology — should provide consistent training and support tools over the life of the agreement. I recommend that a clinic evaluate solution providers primarily based upon that company’s ability to meet all of your clinics needs and then upon the underlying technology that will be utilized.

The third question raised in the article asks about implementing an EMR solution now or in the future. Mr. Ose suggests that the key issue is the right priority and that billing and collections is a “must have” while an EMR solution is a “great to have.” In certain circumstances, I can understand his position; however, I think this is too narrow a view and generally disagree. Having a good EMR solution allows medical and clinical personnel to process patient visits more efficiently and effectively with better quality of care. In addition, an integrated EMR and practice management solution will enable providers to produce more accurate and complete documentation that will ultimately result in a more efficient, comprehensive, and productive billing and collections process, regardless of whether billing and collections is done in-house or by an external third party. A good EMR solution will provide tremendous operational bottom line benefits well beyond that of a billing and collections — only solution. Of course I agree with Mr. Ose that practice management software is a “must have” in partnership with an EMR solution. I would suggest that both pieces are required to have an effective solution. Mr. Ose’s final point on vendor evaluation is good, but I would add that in evaluating billing and collection and EMR software solutions, that you look for the company that can provide a comprehensive solution — EMR and practice management software, hardware, implementation/training and on-going solution support — throughout a long-term relationship.

Benjamin Arnold
Director of marketing, DocuTAP

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