strating urgent care
TRANSCRIPT
Starting Urgent Care Business with Confidence
by Olga Khabinskay
COO of WCH Service Bureau, Inc
Changing Healthcare Industry• Payers want to pay capitation and global rates for services
• Insurances prefer Urgent care clinics - defray the cost of hospital visits
• Insurance companies are the largest payers for urgent care services
• Patient want better access to care:• flexible visit hours• quick results• multispecialty care • less waiting time
• Urgent Care Business Model is the future of healthcare:• Medical practices merging • Hospitals buying practices• Panels are closing for new providers
Making Decision to Start Urgent Care • Creating Business Plan• Specialization: primary care, or specialty care• Payer list for the projected patients• Checking out your competitors• Which competitors your facility can support• Financing: capital for the first year of business
• Establishing Professional Corporation • Location, location, location - Finding the
RIGHT location is CRUCIAL! • UCC contract per location
Making Decision to Start Urgent Care • Space Requirements• Staffing; clinical and administrative • Equipment and supply needs• Preparing the facility for payers contracting• NPI• General & Workers Comp Insurance • Marketing: website, cards, ads, social media
• Working with payers to market your services to patients
Minimum Requirements To Operate Urgent Care• X-Ray Portable or Stationary – Approved by
Department of Health• Other Equipment and Medication cart• Board Certified Medical Director• Hours of operations• CLIA • UC Type: MD Model vs. MD/PA/NP model
Requirements Continued…• Certification – Obtaining Urgent Care Certification
for Facility• Sign: walk in patients are welcomed• Business plan of operations• Photos of the equipment• Role of the medical director• Policy Manual: ethical rules, code of ethics, protocols for
resolving complaints..etc
• Time Frame –4-6 weeks – APPROVAL
Contracting with Payers1. Urgent Care Contract vs. Fee for Service• Medicare, Medicaid and Medicaid Managed Care
plans – fee for service model• Evaluation and Management Contract• CPT codes 99201-99215.
Urgent Care Rates National Statistic:Best Rate: $175Worst Rate: $85Average Standard Rate: $120
Contracting With Payers2. Time Frame – How long before UCC can start billing for services?UCC contracts - 4-6 months
• Understanding rates and responsibilities of the provider• Copays, deductibles, add on codes, global billing• Treat and release model of care. No follow ups
with UC contracts• Site visit by some payers• MD enrollment before UCC enrollment – check
requirements• Effective Date 30 days after contract approval
While you wait…
• Continue your FFS Enrollment • Start accepting patients for services that you can bill back
(Medicare, out of network, Medicaid depending on state requirements)• Introduce your services to the community• Continue calling on your credentialing progress to payers for
FFS and UCC• Continue working on your marketing plan
• Revisit your referral sources every 6 months
Approved! Ready to Start Services
APPROVED -> Start billing from the effective date of your contracts
PANEL IS CLOSED -> Waiting list & Reapply
Approved! • Front desk operations are the key to
the success of your center• Eligibility and Copay• Know your rates before rendering
services• Sending patient to ER is always an option.
The rate might not cover the cost of visit• Educate your staff about your contracts
and rates
Other Important Tips• Obtain EHR/EMR and Practice Management
program• Don’t get tricked into Free system – view all
potential software options• PQRS, E-prescribing and Meaningful Use still applies
even in Urgent Care setting
• Establish billing process:• Hire internally - • Hire professionals in the field - • Understand basic requirements for billing globally
and FFS
Operations Growth and Challenges1. After first year on the market, start thinking about expanding• Adding location• Purchasing another center• Joining a well known chain
2. Negotiating with payers• Option is available after two years in the network
Operations Growth and Challenges3. Increase visit’s by increasing:• Marketing: Flu Season and Preventive Services• Clinical staff• Changing your FFS contracts into Global Rates
4. Consolidation on national level will squeeze out the smaller size urgent care centers – don’t wait expand5. Establish affiliations with hospital system in the area of your center
Any questions?