Our second Urgent Care Start Up segment focused on pharmaceutical dispensing, software implementation and moving toward the opening day. To round out the third installment, we explore some of the last few important factors of completing an urgent care facility: billing and coding, EMRs and diagnostics, along with general advice.
Billing and Coding Trends
The billing and coding department is the financial backbone of the urgent care facility and should not be subject to passing whims. Some trends, however, are worth exploring. “One emerging trend is real-time verification of patient demographics, eligibility, plan benefits, and patient payment responsibility. Unfortunately, too many companies take the easy money and leave the more difficult A/R on the table,” said Matt Dixon, director of client finance at Martin Gottlieb & Associates (MGA). “It’s important to have an internal process that ensures all claims are researched, called on, and worked diligently within appropriate timeframes.”
Adapting electronic methods in medical facilities has also come into light in recent political conversation. Kenny Engel, corporate compliance officer at MGA, said, “Regardless of what happens in the healthcare reform debate, the government is actively transitioning to pay for performance (value-based purchasing). Preparations should be made for 2010 participation in both the Physician Quality Reporting Initiative (PQRI) and the E-Prescribing Incentive Program,” Engel said. “Other priorities include the adoption and ‘meaningful use’ of a ‘qualified’ electronic health record, compliance with the new electronic filing HIPAA Transaction Standard Version 5010, and conversion to the new diagnostic coding system ICD-10. Other critical issues impacting urgent care providers include developing strategies to appeal denials related to the bundling of your services and also learning the defensive techniques necessary to defend your coding methodology against recovery auditors.”
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