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About Your Urgent Care Center
Below is a list of questions that urgent care centers have asked us.
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1. My partners and I are going to start an urgent care in California. Do you offer any publications that may help answer our many questions about starting an urgent care? Read Full Question and Answer
2. I just read in the recent JUCM, the Q&A on "Addressing Problem - based Coding and Other Challenges" and it sparked my interest with a new code. It is the first time that I have heard of the S9088 code. Read Full Question and Answer
3. I am board certified in Family Practice and am currently working in a medical center, which I likely will be leaving due to contract changes. I am interested in the possibility of opening up an urgent care center myself instead of looking for a hospital position. How do I set up a consultation to review the products offered by Practice Velocity as well as discern if this is an appropriate match? Read Full Question and Answer
4. If our clinic has an urgent care that is advertised as such and is open after hours, should we be using POS 11 or 20? Read Full Question and Answer
5. I am part owner of a free standing urgent care center in a community dominated by Medicare and managed care plans. We have only been able to negotiate flat rate payment from most of our managed care payors. Would being hospital-owned or -affiliated give us the ability to negotiate higher rates from managed care payors? Read Full Question and Answer
6. I co-own a family practice next door to our local hospital.I am considering starting up an evening urgent care clinic to increase revenue and to add convenience for our patients. Can you give me any information or advice on how to get the urgent care clinic started with my current assets? Read Full Question and Answer
7. I am in the brain storming stage of planning to open a Sports Medicine/Family Practice/Urgent Care office with a colleague. Right now, I am interested in finding out where to start gathering information on what to do to open the office. I am most interested in gathering data on my time off on topics such as permits, license, certification, etc. Do you have any suggestions for me? Read Full Question and Answer
8. I am currently developing a pro-forma for a startup urgent care center that we are considering. Do you know the CPT codes used to bill visits? Also, what is the reimbursement for these codes? Read Full Question and Answer
9. I just visited www.practicevelocity.com and found it very interesting. What other resources do you believe would be useful for someone such as myself interested in starting a center? Also, is it required that the owner of an urgent care center be a licensed MD? Read Full Question and Answer
10. I am thinking about opening an urgent care center in our area; it would not be related to my current group practice. Do I need to negotiate new contracts with insurance companies for the UCC? Do I need new credentials with these insurance companies if I already have that from my current practice? Read Full Question and Answer
11. What are your thoughts on charging the S9088 code? We currently charge $82, which usually drops to patient responsibility - most insurances are not recognizing it. We currently take the specialty co-pay - and coupled with the S code, patients end up paying around $100 out of pocket. Read Full Question and Answer
12. Would you tell me what CPT code would be the appropriate code to use for a follow-up visit for strep? This patient came in initially for sore throat, the strep test was negative. Read Full Question and Answer
13. Is the definition of 'new' or 'established' different in the case of a hospital based urgent care center? Read Full Question and Answer
14. Are there standard practice guidelines for urgent care or walk-in centers? If so, where can I find them? Read Full Question and Answer
15. I am doing some research on urgent care settings and would appreciate any resources or suggestions for learning the top billing codes in an urgent care setting. Read Full Question and Answer
16. I am new to coding for urgent care. My background is primary care. I have some questions about codes 99051 and 99058. 99051 -- Is there a true definition for evening or should I just use for 5:00 and later? Read Full Question and Answer
17. My office has started to provide urgent care. Should our urgent care services be reimbursed at a higher price than our family practice services? Is there a different “fee schedule”? Read Full Question and Answer
18. I have a group of ED physicians that are thinking about opening an urgent care clinic in the area. Can you give me a ballpark for startup costs for a 3-5 bed urgent care that does limited labs/plain x-rays? Do you have a salary range for urgent care physicians in North Carolina? Read Full Question and Answer
19. I have been speaking to a local hospital that does not have a pediatric ER. The employees at the hospital have to go to another ER for their children. When I spoke to the person in charge of this at the hospital they were very interested in contracting with my center. Do you have any experience with this type of thing? Read Full Question and Answer
20. You reinforced our initial impression that in Florida, the standard reimbursement plans are on the flat-fee model. We will be approaching the major insurers in the next few weeks, Read Full Question and Answer
21. What matrices (for example: demographics, economics, or infrastructure) are available to assess whether or not a community will support an urgent care practice in Southern California? Read Full Question and Answer
22. I just read your article in the May edition of JUCM, which, by the way, was most informative. Can you tell me what dollar amount might be a reasonable amount or national average for payors to reimburse for the 99050 and 99051 codes? Read Full Question and Answer
23. I have been moonlighting at an urgent care center for the past two years, and now the owner has made me an offer to buy the UCC. I am hoping to solicit your advice as to whether you think the price is a fair one. Read Full Question and Answer
24. I had been doing some research on the use of Code 99051 and then I opened the most recent Journal Of Urgent Care Medicine. Read Full Question and Answer
25. My clinic is open to walk-ins during all open hours which are 8-8 m-f and 9-5 on Sat and 1-5 on Sunday. We have lab and x-ray at all times. Read Full Question and Answer
26. We are a new urgent care clinic (6 months). I have read several articles on billing and coding practices for urgent care centers, including your column in The Journal of Urgent Care Medicine. Read Full Question and Answer
27. I am in the process of starting up an urgent care center in Rhode Island. I am an internist/id doc, with plenty of ambulatory experience and plenty of experience working in urgent care centers. I have some questions about putting together our business plan and about billing and coding. Read Full Question and Answer
28. We will begin billing for a free-standing urgent care facility shortly. We have been hearing conflicting information about whether the physician and facility numbers or only the facility numbers need to be put on the claim forms. Can you verify which is correct? Read Full Question and Answer
29. Can I use nurse practitioner as locum providers? How long can they practice? Do we have 60 days to credential them the same as physicians? Read Full Question and Answer
30. I was interested in more information on the "S" Codes. I do have a question though concerning the following: How do clinic licensing and certification affect the reimbursement for the facility? Read Full Question and Answer
31. A new patient comes in with a laceration, I still bill the E&M visits with a modifier 57, because we are billing a surgery code on the same day, not a modifier 25, unless we did do something other than the laceration. Read Full Question and Answer
32. I have a question for you guys. I work as an NP for a large chain of free standing private urgent care clinics here in florida. We do have x ray capabilities, see walk in urgent care, perform physicals, and see various workers comp. patients. Read Full Question and Answer
33. Do you routinely send out for wound or urine culture and sensitivity in your urgent care centers? Read Full Question and Answer
34. I have a question for you. We are a family practice center with an urgent care emphasis. We are having a hard time with billing. How can we get more for the urgent care visits than for the regular family practice visits? Read Full Question and Answer
35. Dr. Stern, I enjoyed reading your article "How to Define a Type B ED" in a recent JUCM journal. I have a question I would greatly appreciate an answer to. I am the medical director of a number of hospital owned urgent care centers. Read Full Question and Answer
36. We recently opened our first urgent care, and there has been some disagreement on charting. Where can we find documentation on the required charting for an urgent care? Read Full Question and Answer
37. I was wondering if you can give me a code to begin with to review with the Blue Cross Contracting department for payment needs for a urgent care facility that we operate. Read Full Question and Answer
38. In reading your Q & A answer in the Feb. 2007 JUCM the criteria you listed for type B emergency depts is also the criteria definition as to whether UCC meet EMTALA requirements. Read Full Question and Answer
39. Do you have any experience in dealing with urgent care centers who work under the license of hospitals? Do they also have to bill with office codes? Also, can you weigh in on whether or not our urgent care physicians should be independent contractors? Read Full Question and Answer
40. I am a new coder for an Urgent Care located in Texas. I am excited about learning anything and everything about urgent care. Thank you for the article on when to use the modifier 25. Read Full Question and Answer
41. Here are some facts about the location where we are considering starting an urgent care center. Is this a good location for a startup UCC? Read Full Question and Answer
42. Can you tell me what guideline is being used for compliance when the physician signs off on the statement of "I certify that I have reviewed all of the data on all pages of this form, and I deem the exam clinically appropriate for this visit?" Read Full Question and Answer
43. I am a RN currently working in my town's local ED. I am working towards my Masters. My ultimate goal is to be a nurse practitioner in adult health or acute care. I've been researching urgent care facilities and in my research I've found that these practices are generally run and/or started by a physician. In your work, have you heard of or seen a facility started up by an NP? Read Full Question and Answer
44. May I ask what CPT code you use to perform a Wood's Lamp Evaluation to diagnose or not diagnose a Corneal Abrasion? Read Full Question and Answer
45. I work for a doctor who is trying to find out what the urgent care codes are. Could you tell me where to find this information in the CPT book and what code range? Read Full Question and Answer
46. My question is what ICD-9 code, other than a fussy baby can be used when a parent brings in a child. Read Full Question and Answer
47. Do you know where I can find some information on structuring the ownership of an urgent care center to permit non-physician owners? Read Full Question and Answer
48. I'm a certified coder working for St. Louis Connect Care Urgent Care Center. It was brought to my attention that we may not be billing E/M visits correctly. Read Full Question and Answer
49. Is there any way to obtain records regarding the number of patients an average urgent care physician sees per shift. Read Full Question and Answer
50. I am looking for a set of pre-printed patient discharge instructions. Read Full Question and Answer
51. We are attempting to pull some equity out of the value of our facility but are having a tough time finding business comps for a professional urgent care. Do you have some or know where I might be able to find some? Read Full Question and Answer
52. I am looking for information regarding opening an urgent care facility in Georgia. Read Full Question and Answer
53. I was wondering if you could tell me what you expect from your providers as far as number of patients seen per hour per provider. Read Full Question and Answer
54. Do you have figures of the average salaries for PAs in Urgent Care? Read Full Question and Answer
55. We would like to begin using S9088 and are currently checking reimbursement. Read Full Question and Answer
56. We have enjoyed our initial 8 months of operation and are looking forward to opening our second clinic in August. I am searching for data regarding urgent care industry standards to assist me in monitoring my own center and to supply more information to the building owners/developers with which I am doing business. Read Full Question and Answer
57. I stumbled onto your website in my frustrated search for an improved practice style and am interested in what you might have to offer. I own my own family practice (and the building), and we are having difficulties with being on hospital call. Read Full Question and Answer
58. I work in an area that has an increasing need for more urgent care centers. I am interested in establishing an urgent care center, but I am a toddler at this. My first question: how do we find the necessary funds? Read Full Question and Answer
59. How easy is it to get insurance companies to recognize you as a health care organization? Also, have you heard of any "franchise" opportunities in the urgent care industry? Read Full Question and Answer
60. I recently took a job at an Urgent Care Center and realized when we billed an E&M code with other codes such as 90772, 94760, 94664 and 99173 they will bundle. Read Full Question and Answer
61. I’m writing to you today to inquire about your recent presentation “Blending Occupational Health and Urgent Care,” which I unfortunately was not able to attend. We have been considering creating exactly what your talk title indicates: a model including urgent care/convenient care with occ med. Read Full Question and Answer
62. We bill for 4 clinics that are licensed as "outpatient clinic". We are confused on the place of service code because the 22 states the facility is part of the hospital... Read Full Question and Answer
63. My medical director and I were talking about the possibility of us getting trained to do slit lamp exams as well as burr rust rings. You had mentioned that each of your physician colleagues is trained to feel comfortable doing these procedures. How are they trained? Read Full Question and Answer
64. I am trying to open an urgent care center in New York and am having difficulty finding regulations. Do you have any information that may be useful? Read Full Question and Answer
65. I have a place 20'x50'. Could this be adequate to start an urgent care center? Read Full Question and Answer
66. The agency that I work for presently provides hospice, home health and mental health services. If we were to open an urgent care facility, when would we begin with the licensing/permitting process? We have RNs and LPNs and two physician consultants, but the owners are not physicians. Where do we start? Read Full Question and Answer
67. Our corporation is building a new business/office complex with plans to include an urgent care. Read Full Question and Answer
68. Is there an established method of valuing an urgent care business for the purpose of a purchase/acquisition? Read Full Question and Answer
69. How do you determine what to charge for drugs administration in urgent care? Read Full Question and Answer
70. I want to know if you have some good suggestions and input for negotiating with an insurance company that wants to offer us a flat-rate contract. Read Full Question and Answer
71. We are interested in finding out information on your software, mainly on rooming of patients (time to room), discharge instructions, and documentation. Read Full Question and Answer
72. What is required by the state of New York to open an Urgent Care Facility? Read Full Question and Answer
73. I am in search of documented information to validate or negate a billing question. Read Full Question and Answer
74. Are many urgent care clinics started by mid-level providers...? Read Full Question and Answer
75. Do you carry software that allows patients to sign-in electronically from their homes/offices for urgent care appointments? Read Full Question and Answer
76. If I open an urgent care facility as a non-physician for some time now, how can I attract a physician to practice out of my facility? Read Full Question and Answer
77. I am thinking of changing my 8 month old internal medicine clinic into an urgent care center. Read Full Question and Answer
78. In your blog you stated to use $100-$110 as a net per visit at an urgent care. Can you give me a corresponding Gross for that number? Read Full Question and Answer
79. I am planning to open an Urgent Care in a downtown metropolitan city in Missouri. How should I approach the subject of EMRs and coding? Read Full Question and Answer
80. Do you by any chance have a timeline available for starting up a minor medical/ urgent care center? Read Full Question and Answer
81. I own and operate an urgent care facility that meets all the criteria you refer to in your recent Coding Q&A. Read Full Question and Answer
82. My client is a new (3 month old) Urgent Care Center whose business and marketing plans... Read Full Question and Answer
83. Are you an urgent care consulting or an urgent care franchising body? Read Full Question and Answer
84. We are interested in the EMR component. How much is it? Read Full Question and Answer
85. In one of your lectures you had mentioned that some states are regulating the types of signage and the names that urgent care facilities can use. Can I have additional information on this issue? Read Full Question and Answer
86. I have an urgent care/primary care practice that last year had a total revenue of $2 million. Who would I speak with if I wanted to find out my practice's current worth? Read Full Question and Answer
87. How successful have you been with getting the MCOs to approve Problem-Based Coding (PBC)? Read Full Question and Answer
88. Is there a recommended workshop/seminar for urgent care billing and coding? Read Full Question and Answer
89. For uninsured patients, how much discount should be given? 70% off charges? Read Full Question and Answer
90. I would like to gain expertise in urgent care coding and billing. Can you please advise if there are study guides, reference books, or online programs available specific to this area?Read Full Question and Answer
91. I am trying to get correct coding for a client of ours who is an urgent
Care facility. Read Full Question and Answer
92. Is there a recommended formulary list available for setting up an urgent care clinic? Read Full Question and Answer
93. An issue came up regarding billing for an avulsion laceration of a finger where the use of gel foam was applied. Read Full Question and Answer
94. We have an urgent care/walk in clinic. Are we supposed to use the 11 point of service code for Non-Urgent visits... Read Full Question and Answer
