Attorneys For Urgent Care Centers

With major alterations in our healthcare system, urgent care services are taking on a new role. That new role comes with a number of legal and regulatory challenges for urgent care providers. The New York healthcare attorneys of Norman Spencer & Associates can help with those challenges. Our legal team has extensive experience representing urgent care practices and providers in a wide scope of legal and regulatory matters.

Some of the more common issues facing New York urgent care providers include:

• Fee splitting
• Prohibited corporate practice of medicine
• Audits by zone program integrity contractors (ZPIC), recovery audit contractors (RAC), Medicare administrative contractors (MAC), and the office of Medicaid inspector general (OMIG)
• Audits by private insurance companies
• Stark law, as well as federal and state anti-kickback statutes
• Compliance with Medicare and Medicaid regulations
• Compliance with Stark, HIPAA, EMTALA and other state and federal regulations and statutes
• Government investigations of abuse and fraud
• Business management issues, such as mergers, corporate formation, physician contracts, internal compliance and practice setup
• Sales and purchases of practices
• Credentialing and accreditation

The lawyers at Norman Spencer & Associates assist New York urgent care providers with all of these issues.

New York regulations dictate that urgent care be differentiated from emergency care. “Urgent care” is a term reserved for medical providers treating minor traumas and acute episodic conditions. Emergency services are provided for major traumas, as well as disabling or life-threatening conditions.

Adhering to that definition, urgent care centers do have limitations on the type of services they provide. They still have a wide scope of options, which can be administered to unscheduled walk-in visits. The range of services urgent care centers may provide include:

• EKGs and X-rays
• Lab services and phlebotomy
• Administration of IV fluids
• Administration of medications, specifically oral, subcutaneous, sublingual, respiratory and intravenous medications
• Stitching of certain types of laceration wounds

Additional New York regulations outline terms that must and may not be used by urgent care centers. The term “Urgent Care” must be used in their business names, on their signs, and on their websites and other materials. Urgent care centers are prohibited from using the word “emergency,” as emergency care services require specific licensure from the government.

New York healthcare providers who want to provide urgent care services are required to apply for the designation. An application must be submitted to and approved by the New York State Department of Health (DOH). Different approval processes are required for different types of entities with regards to Article 28.

Article 28 is a state public health law that regulates and recognizes the accreditation of hospitals, nursing homes and other public healthcare facilities. Article 28 providers that want to provide urgent care services are typically subjected to a limited review by the DOH.

Private physicians affiliated with an Article 28 provider may offer urgent care services, but only under select circumstances. They must either be accredited or certified by an organization approved by the DOH or they must become an Article 28 provider.

Healthcare providers that don’t fall under the Article 28 classification need to take a different route in order to provide urgent care services. They must be accredited or certified by accrediting organizations approved by the DOH.

If this seems complicated, or you’re not sure what steps to take to be legally able to provide urgent care services, the attorneys at Norman Spencer & Associates can help. Our lawyers can assist New York healthcare providers with matters relating to DOH accreditation and approval while guiding you down the appropriate route to take.

As urgent care centers and the patients they treat continue to grow across New York state, urgent care has come under increased scrutiny. This can be seen in the increased number of audits by Medicare, Medicaid and private payors. Insurance audits tend to result in overpayment demands, but they can also lead to various sanctions. These may include recoupment actions, exclusion from Medicare and Medicaid, and other penalties.

One of the most common types of audits is the review of billing documents urgent care providers submit for Medicaid payment. In fact, the New York OMIG has increased the number of audits across the industry.

Auditors are prone to focusing on an array of common billing issues, such as:

• Billing for services that are not authorized under the operating certificate
• Billing for services that were denied due to absence of medical necessity
• Incorrect identification of provider on submitted claim
• Incorrect diagnosis codes
• Lack of satisfactory explanation of services
• Orders lacking signature of qualified practitioners

Avoiding these and other mistakes is much easier with an effective compliance plan in place. Such a plan helps to maintain proper billing practices while avoiding unintentional errors. The attorneys at Norman Spencer & Associates are available to help urgent care practices create a tailored compliance plan that helps to protect you at all stages of audits and appeals.