Diagnosing the increase in surprise bills at urgent care centers

July 24, 2015

Happy Friday to our readers! This week, FierceHealthFinance took a look at the increase in surprise bills at urgent care centers, which it says occur when patients unwittingly use out-of-network providers while incorrectly assuming that they’ll be fully covered by their insurers. With contractual arrangements between payers and providers changing constantly, patients may not always be made aware of such changes in a timely fashion.

This trend demonstrates how important it is for providers to verify each patient’s eligibility and accurately estimate their total financial responsibility up front, then collect it or set up a payment plan before providing service.

HealthLeaders compares the recently announced one-year transition period for ICD-10—during which CMS says it won’t deny claims based solely on the use of an unspecified diagnosis code if the code comes from the correct “family”—to “friends and family” cell phone plans. The piece points out that CMS hasn’t yet defined what it means by a “family” of codes, and considers several possibilities.

We think the smartest approach is to focus on trying to use the correct specified diagnosis codes—which you’ll have to do anyway by the end of the first year—right from the go-live date, and think of CMS’s transition plan as a temporary “just in case” safety net. Check out our handy ICD-10 infographic on “6 Steps to ICD-10 Success,” then use our Coding Tools on a daily basis to help you find the right codes more quickly and easily.

Finally, you won’t want to miss our upcoming webinar with Meaningful Use expert, Elizabeth W. Woodcock, MBA, FACMPE, CPC, next Tuesday at 1:00 pm EDT. She’ll be going over ways to identify potential bonus payments and penalties, and discussing the new criteria for Stage 1 and Stage 2 MU. But hurry—it’s coming up fast! You can register for this free event here.

Stay Informed