Blue Cross Blue Shield in Georgia recently started requiring UCAOA accreditation to centers that want to contract as “urgent care.”

The payor specifically requires “accreditation by an appropriate, recognized accrediting body;” or, in the absence of such accreditation the payor may evaluate a Medicare, state, or designated independent site survey within the past 36 months.

Since most urgent care centers are not affiliated with a hospital, but are rather “physician’s offices,” they do not require a Medicare inspection. And, most states (outside of Arizona and New Hampshire) do not require state inspections.

That leaves urgent care centers with the following options: to earn accreditation through the UCAOA, Accreditation Association for Ambulatory Health Care, Institute for Medical Quality, or Joint Commission.

This raises several new potential issues for urgent care centers as they navigate the contracting process.

  1. There’s an extended timeline to profitability for new centers, weakening the business case for new urgent care growth (which in turn limits access).
  2. There are added layers of bureaucracy in the contracting and credentialing process.
  3. This could limit the ability for new business models to get up and running, dampening the opportunities for innovation in the urgent care space.

The official guidance from the UCAOA for urgent care centers is to “seek accreditation up to 6 months prior to opening their first clinic (startup organization). An attestation is available for a senior level officer to complete (with notary) attesting that the new location will meet all the standards for accreditation and certification at the time it opens. Additionally, the organization must submit the appropriate application and associate fees 45-60 days prior to opening. Prior to opening, an on-site survey must be scheduled 30-60 days after anticipated opening. If the survey has not been scheduled and the organization desires to withdraw the application, the accreditation status will be lost and the organization will forfeit 50% of the full amount paid as well as any non-reimbursable expenses including travel arrangements already made. If opening is delayed and surveyor travel has already been scheduled (airfare booked), any travel related change fee would be recovered by the organization.”

Have questions? Contact one of our Contracting & Credentialing specialists for help today. Call 888-357-4209 or click here.