strating urgent care

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Starting Urgent Care Business with Confidence by Olga Khabinskay COO of WCH Service Bureau, Inc

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Page 1: Strating Urgent Care

Starting Urgent Care Business with Confidence

by Olga Khabinskay

COO of WCH Service Bureau, Inc

Page 2: Strating Urgent Care

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

Page 3: Strating Urgent Care

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

Page 4: Strating Urgent Care

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

Page 5: Strating Urgent Care

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

Page 6: Strating Urgent Care

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

Page 7: Strating Urgent Care

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

Page 8: Strating Urgent Care

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

Page 9: Strating Urgent Care

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

Page 10: Strating Urgent Care

Approved! Ready to Start Services

APPROVED -> Start billing from the effective date of your contracts

PANEL IS CLOSED -> Waiting list & Reapply

Page 11: Strating Urgent Care

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

Page 12: Strating Urgent Care

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

Page 13: Strating Urgent Care

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

Page 14: Strating Urgent Care

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

Page 15: Strating Urgent Care

Any questions?