Questions for Dr. Stern

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11. What are your thoughts on charging the S9088 code? We currently charge $82, which usually drops to patient responsibility - most insurances are not recognizing it. We currently take the specialty co-pay - and coupled with the S code, patients end up paying around $100 out of pocket. I am beginning to be slightly uncomfortable with that - its more than their ER co-pay! What co-pay does your clinics accept - and what is the average out of pocket expense a patient pays for a visit? I would imagine after renegotiating contracts, reimbursement gets better - but at 109% of Medicare - it doesn't quite seem to cover costs. Do you charge patients for any oral meds at the time of service or is there a way it can be submitted for their prescription benefit?

S9088: $82 may be a little high, but some payors are paying this. You might want to consider setting it at your current max reimbursement contract. Note: You probably know this, but just for clarification. If you are in contract and payors deny a code, then you should write off the code and not balance bill the patient.

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David Stern, MD, CPC CEO, Practice Velocity Partner, Physicians Immediate Care Board Member, Urgent Care      Association of America Dr. Stern helped design the patented Practice Velocity template (PiVoT) that is now used in over 600 urgent care centers. He is board certified in internal medicine and served as Chief Resident in Internal Medicine at Pennsylvania State University. Dr. Stern received his medical degree from Jefferson Medical College of Thomas Jefferson University after completing undergraduate studies at Houghton College in Houghton, NY. Dr. Stern serves on the Board of Directors of the Urgent Care Association of America (UCAOA). A Certified Professional Coder, Dr. Stern writes articles and presents at numerous national and regional conferences on topics, including medical charting, emr, medical coding and medical practice management. With additional partners of John Koehler, MD (CEO) and Terry Buzzard, MD (Regional Medical Director), they operate the urgent care consulting firm of National Med Network and the ten clinics (in Illinois and Oklahoma) of Physicians Immediate Care.

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