Urgent Care. Snayhil Rana

Transcription

1 Urgent Care Snayhil Rana

2 Urgent Care : From the baseline Urgent care centers provide walk in, extended hour access for acute illness and injury care that is either beyond the scope or availability of the typical primary care practice or retail clinic. Some of the most common conditions treated are fevers, upper respiratory infections, sprains and strains, lacerations, contusions, and back pain. Most centers also treat fractures, can provide IV fluids, and have x ray and lab processing onsite. Urgent Care is also called as Acute Care. Who is Involved in UC??? Physicians Physician assistants Nurses Nurse practitioners Medical assistants Radiology technicians. Typical Business Service Hourin UC Urgent Care open between 8 and 9am, and close between 7 and 9pm on the weekdays. UC Facility Usually located in freestanding buildings, and the majority of centers are Most of those are located off the main hospital campus.

3 Urgent Care : From the baseline Urgent care licensure In most states, urgent care centers are licensed in the same way as a typical physician practice. There is not separate licensure for UC. Urgent care centers may also provide other healthcare services in addition to treating common and acute illness and injury. Many centers provide occupational medicine services, travel medicine services and sports and school physicals. Why Urgent care??? - No appointment needed. - Convenient locations - Extended hours. - Expanded service - Cost efficient.

4 Urgent Care : Alliances with other facility For Urgent Care Center it is always recommended to have alliance and integration with other kind of facility in Order to provide specific patient services on request. Alliance with Emergency Department Services. Alliance with Hospital Services Alliance with general medicine and independent physician Services Alliance with specialty physician.

5 Urgent Care : Business Statistics Approximately 8,000 centers in the U.S.. 85% are open 7 days/week. Average of 314 weekly patient visits per center Over 100 million visits annually. Locations: Urban 25% Suburban 55% Rural 20% Physician Specialties Family Physicians 54.3% Emergency Medicine 21.7% Internal Medicine 15.2%

6 Urgent Care Vs Emergency Care Time and Availability An emergency room connected with a federally funded hospital is required to provide 24 hour emergency care. An urgent care center may be privately funded, which means it has the right to assign its own hours of operation. It would not be unusual for an urgent care center to close at 11 p.m. and reopen at 7 a.m. the next morning. Anyone seeking immediate treatment between those hours would most likely be urged to visit a traditional emergency room. Expenses One important difference between an emergency room and an urgent care center is the expense. Anyone who has visited an emergency room for a relatively minor situation may relate to the idea of high price tag. Many emergency rooms are required by law to provide emergency treatment to anyone who requests it, regardless of the patient's ability to pay. Urgent care involves conditions which could develop complications, but are not life threatening.

7 Urgent Care : General Type of Patient Care Chest Pain Allergy visit Poisoning Pediatric Trauma Fracture Visit Psychiatric Evaluation Neurologic Exam Eye Problem Exam Emergency Contraception Form Abdominal Pain Exam Sore Throat Encounter Skin Problem Visit Labor & Delivery ER Visit Physical Exam Adult with Diabetes Specific Exam

8 Urgent Care : Option of Treatment

9 Urgent Care : Medical Coding and Billing Pittfall Urgent care is, as the name suggests about services which are required for an illness or injury that would not result in further disability or death if not treated immediately, but does need professional attention as it has the potential to develop such a threat if the treatment is delayed longer than 24 hours. It is necessary to follow a proper billing and coding process so that all claims are reimbursed and no claim gets lost. However billing mistakes commonly do happen in urgent care billing services and claims can get rejected for various reasons. The reasons include ; Using wrong diagnostic codes Rejection due to non specificity of codes On validation about medical necessity of service Indirect linking of codes Replacing physician services with physician assistants (PAs) or nurse practitioners (NPs)

10 Urgent Care : Medical Coding and Billing The reasons include. Less experienced coder Hiring a not certified professional coder Billing confusion over "incident to" services Inefficient collection at the front desk staff Urgent care center doing laboratory tests without a CLIA (Clinical Laboratory Improvement Amendments) waiver. Using durable medical equipment (DME) without a separate billing number Using staff not aware of changes in healthcare reimbursement that affects payments Coder not trained specifically for urgent care Wrong person signing for "minor" patient claims Not verifying at the outset the guarantor's insurance card and identification Using CPT codes meant only for hospitals Not being able to distinguish between new and established patients It is true that there is often a shortage of urgent care specialized coders but one must remember that wrong coding can delay payments or even lead to litigation.

11 Urgent Care : Need To take Care.. That Physician services in urgent care centers should be billed with (office or other outpatient visit for the evaluation and management of a new patient). Physicians in urgent care centers cannot use the emergency department service codes. For the Urgent Care to be competitive, it must offer managed care plans an affordable alternative to the emergency department for minor, episodic, unscheduled medical care.

12 Urgent Care : Mind Your.POS Is this urgent care center affiliated with a hospital and is it attached to the hospital or away from the hospital? Are you going to bill using the hospital's tax ID number or does the center have it's own Tax ID Number. There are urgent care centers that are not affiliated with a hospital. Urgent Care Center billing uses the office E/M codes ( and ). These claims are submitted on a CMS 1500 form. POS Code 23 is used for services provided in a hospital emergency department, not an urgent care center. An Urgent Care Center will use POS 20. One thing to know, many carriers may not approve care provided in a non contracted urgent care center, especially when the patient belongs to a provider network. This is because the care provided in an urgent care center is not deemed to be an emergency. Therefore, authorization would be required to be obtained prior to administering care to a non contracted HMO member.

13 Urgent Care : Starting a new venture Write a Business Plan: Anyone thinking about starting an urgent care center should spend the time to sit down and write a business plan. The discipline of thinking through the many issues involved in starting an urgent care are.. Is a joint venture urgent care with a hospital a good idea? Are you going to be a simple physician owned medical practice? Does one of the new urgent care franchising models make sense? Is there a successful local urgent care chain, with which you could join forces If yourcenter willbe owned by non physicians, then you need a lawyer with specific expertise in setting up a medical practice with non physician owners in your state. Many lawyers have set up medical practices with physicians or hospitals, but the legalities in many statesare very different(and quite rarely known by lawyers, even lawyers with healthcare expertise) for owners that are not physicians or hospitals.

14 Urgent Care : Starting a new venture Decide an Urgent Care Location The idealcity for a new urgent care center has at least 40,000 people in the area and does not have any other urgent care centers in the community. If you choose a community that alreadyhas adequate urgent care access, aninadequate insured population or an overabundance of primary care physicians (which is quite rare) then your chances of success will diminish.

15 Urgent Care : Starting a new venture Find the Urgent care community You will need to determine the most cost effective method to make the community aware of the services available in the starting of your urgent care center. Various urgent care centers have found effective multiple different methods, including billboards, grand openings, newspaper advertisements, radio spots, drive through flu shot clinics, newsletters, and many other original ideas. Be careful that you do not overspend on advertising, as many centers underestimate the amount of capital that will be needed to operate the urgent care center for the full year. Choosing an adequatecommunity is important, but you will also need to find the correct street address for your urgent care center. A freestanding building on a busy thoroughfare is ideal but not necessary for success.finding the ideal location may be difficult. An excellent startup consultant should be able to direct you to a realtor with national expertise in helping you find the best location for an urgent care center.

16 Urgent Care : Starting a new venture Select Services to Offer A few urgent care centers focus only on serving walk in patients from the community at large. Other urgent care centers choose to combine primary care medicine and walk in services in the same facility. A common model for urgent care centers incorporates occupational medicine services in addition to walk in services. Local corporations are often delighted to have local clinic that will serve their needs for treatment of workers compensation cases, post offer physical examinations, drug screening, executive physical examinations, and provide other corporate medicine services.

17 Urgent Care : Starting a new venture Market Your Urgent Care: You will need to determine the most cost effective method to make the community aware of the services available in the starting of your urgent care center. Various urgent care centers have found effective multiple different methods, including billboards, grand openings, newspaper advertisements, radio spots, drive through flu shot clinics, newsletters, and many other original ideas. Be careful that you do not overspend on advertising, as many centers underestimate the amount of capital that will be needed to operate the urgent care center for the full year. Contracting and Credentialing: Startup urgent care centers are often amazed to find that so many patients call and ask if the clinic "takes" their insurance. What they are really asking in most cases is whether the urgent care center is contracted with a particular insurance company.patients pay a significant portion of their paycheck for their health insurance, and they expect to be able to use that insurance at their urgent care center.it is rare for a center to start this soon enough, as the full process can take six months or more.you will want to use a contracting professional with specific expertise and vast experiencein urgent care contracting and credentialing. Itiscritical tohave the contracts expeditiously initiated and completed and to secure the best possible rates available in your community.

18 Urgent Care : Starting a new venture Find a Billing Company: Urgent care billing is unique. You will want to find a billerwith specific knowledge in the intricacies of urgent care coding and billing. Urgent care centers started by hospitals often use hospital billers with no expertise or interest in urgent care billing and coding. Other urgent care physician entrepreneurs choose to use an inexperienced spouse or receptionist to bill claims. Either error will lead to serious financial difficulties, as inefficient billing and collections of revenues will strangle the financial lifeblood out of a startup urgent care center.

19 Urgent Care : Starting a new venture Implement appropriate Technology (EMR) It is critical to find software that will make your urgent care center operations more efficient and successful. Most software solutions are designed for must slower paced practices than urgent care centers. In addition, most EMR solutions do not have significant functionalities for occupational medicine. The wrong software choice can significantly slow down the clinical throughput and seriously degrade your revenue cycle management.

20 Urgent Care : COPIS

21 Urgent Care : PDCA

22 Urgent Care : In The Nutshell Always Take care about Location, as it is having highest impact on Urgent Care center. Generating Opportunities and Marketing is also an integral part of Business plan to start up a new project for Urgent Care. Don t Confuse Between Urgent Care and Emergency Department. POS used for Urgent Care is 20. Have a proper setup, infrastructure, logistics, medical equipment and medical supplies in order to full fill the patient need. Proper Training and Time Management is a key to success of Urgent care Facility. Also, it is needful to have specialty, Inpatient Hospital and emergency department in network of a urgent care facility center. As Urgent care Medical Billing and reimbursement is unique, Facility need proper technology along with capable Medical Billing vendor.

23 Thank You