Mistake #18 — Thinking Compliance is Not Important
It’s not wise to violate rules until you know how to observe them.
— T.S. Elliot
If you don’t think you have to worry about coding compliance in the first few months after opening, you are correct in thinking that no payer or regulatory agency is likely to audit your charts for compliance in the first few months after opening. You are correct that hospital systems are much more prone to big audits and big fines. You are correct that so-called compliance experts often make compliance into a complex quagmire? But ignoring coding compliance can lead to serious issues as your practice grows. Just a few real-life examples of urgent care centers show the importance of coding compliance:
- A national managed care organization (MCO) asked a four-center urgent care to refund $1.5 million for what they interpreted as inaccurate documentation and coding. Much of the MCOs claims were spurious and based on inaccurate information, but the initial legal bills for this urgent care practice went over $100,000 before the case even got off the ground. That same practice implemented Practice Velocity solutions and subsequently passed audit after audit with flying colors.
- An urgent care practice settled with Medicare for five figures (certainly with six figures of legal expenses) for not strictly following the “new patient” vs. “established patient” rules established by Medicare. This occurred, even though many argue these rules actually should not apply to true urgent care centers.
- Some centers have threatened national boycotts of urgent care centers if a national MCO does not agree to treat urgent care centers differently from primary care physician practices. Of course it is perfectly legitimate to make these types of requests for your urgent care center, but a national collusion of urgent care centers would violate anti-trust statutes; and even threatening such a boycott could result in an extremely expensive legal case.
Build a culture of compliance in your startup urgent care center from day one. You will never see the problems that never arise because you have built a culture of compliance. However, you will reap the benefit of sleeping soundly every night in the assurance that your center is in full compliance with every known rule and regulation.
The good news for Practice Velocity customers is that Practice Velocity solutions have taken coding compliance to the next level for new urgent care centers. From day one, Practice Velocity customers have every patient visit electronically audited for coding compliance for the evaluation and management (E/M) code. This takes the guesswork out of determining the level of the code.