Questions for Dr. Stern
About Your Urgent Care Center
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.
