Questions for Dr. Stern
About Your Urgent Care Center
82. Perhaps you can clarify something for me and my client, an Urgent Care Center. My client is a new (3 month old) Urgent Care Center whose
business and marketing plans very carefully emphasized that they are an UCC. Payer contracting also emphasized this, as does their signage and
advertising. On our advice, they bill S9088. As they opened for business before all managed care contracting was completed, some claims
were adjudicated as out of network, allowing the S9088 but assigning it to patient deductible. Some patients have complained about getting a
bill for this as the practice did not explain well at the time of billing. The practice would now like to triage their patients into "urgent" and "primary care" patients and not bill the S9088 on a consistent basis. We have advised against this as many commercial
payers in our market do recognize the code. Our point is they ARE an UCC and should not feel squeamish about explaining this to patients as
they walk in the door! Do you have advice on holding oneself out to be both UCC and "primary care"?
As you are seeing, startup urgent care centers are quite challenging.
There are several issues here:
- Docs being squeamish about taking money. This is very common and reacting to a few complains (rather than hundreds of payments) is a common mistake. Whether you explain it up front or not, some patients will complain. It makes good sense to include this in the release that patients sign when they sign into the center.
- Out of network issues: even when in network, some payors will place S9088 to patient responsibility.
- UCC and primary care: This should be done on a consistent basis, e.g., based on the fact that the patient has designated the center physicians as the primary care provider. It should not be done based on whether the insurance adjudicates the code to patient responsibility.
- S9088: for Colorado workers compensation, there are very specific and stringent rules that the center must meet.
