Every year, we work with dozens of urgent care clinics and would admire to work with yours. Each proposal is carefully designed by us round your particular requirements but can manage almost every aspect of the start-up procedure involving the contracting, credentialing, marketing, lab setup and accreditation process. We’ll love to work with you to get your Urgent Care clinic certified deployed on the UCAOA (Urgent Care Association of America) criteria and can have you operational and compliant in no time at all. An overview of our credentialing services and the UCAOA instructions for new urgent care centers is mentioned below.
Urgent Care Start-Up and Credentialing
The foremost thing you require knowing is that the reimbursement for urgent care services have went down over the years while the key instructions to be reviewed an urgent care have increased. Actually, insurers consider many of our urgent care centers as primary care / internal medicine clinics to get around having a global fee. You must fit into one of the 2 categories mentioned below if you do wish to be credentialed as a true urgent care. You’ll get compensation in the sort of a global or flat fee which covers everything that sufferer could require while at your office if contracted as an urgent care. This usually works well in few areas while in others; it makes more sense to bill for each and every service separately like you would in a primary care setting.
Entire urgent care clinics must go through a credentialing and contracting procedure with all government and commercial insurance companies, regardless of which direction you end up going. Most often we’ll have a medical director (MD/DO) who leads and supervises the operation and 1 or 2 NP/PAs that work in the clinic full time. We credential the entity and make certain that every provider under the entity is credentialed unless the urgent care center is capable to satisfy the credentialing standards of payer through their internal procedure. The complete time it consumes to credential and contract a latest urgent care is generally 3-6 months relying on the payer and the place.
Description of the UCAOA instructions/guidelines:
Certification of Category 1 or Category 2 will be received by Certified Urgent care Criteria Facilities relying on their staffing model:
Category 1 = licensed physician (MD/DO) on site during entire posted hours of operation
Category 2 = licensed practitioner (MD/DO or NP, PA) on site during entire posted hours of operation (mixed models)
Entire services and facilities, regardless of staffing model, must meet or exceed all of the minimum criteria below:
1. Facility must agree and advertise that walk-in sufferers of all ages are accepted for a broad spectrum of sickness, wound and disease during entire hours the facility is open to see sufferers. Pediatric specialty centers are exempt from above age requirement IF pediatric-only specialization is involved in the name of the facility.
2. During entire posted hours of operation, the following must be available for the facility: Phlebotomy services on site, X-ray on site, Licensed provider on site with the suitable state licenses and resources to: get and read an EKG and x-ray on site administer PO, IM & IV medication/fluids on site perform minor processes on site The following tools and devices, and staff trained in its use: ambu-bag/oral airway drug cart stocked rightly for patient population, working phone to dial 911, automated external defibrillator (AED) oxygen, Nearly 2 exam rooms, separate waiting area and restricted access patient restrooms
3. Minimum hours of operation (must meet entire 3 conditions or criteria) seven days/week (not involving national holidays) 4+ hours per day 3000 hours each year. Special cases will be considered for a facility if all of the following are met (see application) alternatively: Facility is part of a multi-center system, Facility is open 5+ days/week (not involving national holidays). Another facility that is part of the similar system meets standard minimum hours of operation criteria [Criteria 3] AND is less than or equal to 5 miles away
4. A licensed physician must be there by the Facility which is designated as Medical Director for the facility who is accountable for overall clinical quality.
Criteria for Eligibility
Few practice types and facilities are unlikely to meet entire above minimum criteria and hence would be excluded from eligibility for certification as an urgent care center. When applying, these facilities should use extreme caution, as fees aren’t refundable. Few instances include:
• Chiropractic offices Pain clinics Centers not still open to see sufferers.
• Retail or similar clinic with restricted scope of service situated within a pharmacy, supermarket or similar retail facility
• Physician offices with merely selected hours for walk-ins