1. What exactly is an urgent care center?
2. Should I visit an Emergency Room or an Urgent Care?
3. When should I visit my Primary Care Physician as opposed to an Urgent Care?
4. Should I call my family physician first?
5. What information should I bring with me when I come to the Urgent care facility?
6.
Do you take appointments?
7. What is the wait time at HCUC and MFMEC?
8. What information should I bring with me when I come to the Urgent care facility?
9. What are your hours of Operation?
10. How qualified are the physicians at HCUC and MFMEC?
11. What does it mean when my doctor is Board Certified in Urgent Care Medicine?
12. What about the other staff at HCUC and MFMEC?
Financial / Insurance Questions
13. What insurances do you take?
14. What forms of payment do you take?
15. Who do I contact with Billing Questions?
Urgent Care Codes ("After Hours" etc)
16. Why is the “After Hours” fee (CPT 99051) on my charges when I was seen during the normal operating hours of the Urgent Care Center?
17. Why does the urgent care use these “add on” urgent care codes when my primary care physician does not?
18. What other "add on" urgent care codes might I see on my bill?
19. Does my insurance "cover" the "add on" urgent care codes?
20. Does an Urgent Care visit cost more than a visit with my primary care physician?
21. Why is the cost of care higher at an Urgent Care Center compared to my regular doctor’s office?
22. If Urgent Care cost more than my doctor’s office, why should I use an Urgent Care Center?
23. Do some Urgent Care Centers cost more than others? Does HCUC and MFMEC cost more or less than other urgent care centers?
24. Can I just come in for a Drug Screen and how much does it cost?
25. Do you make appointment for Drug Screens and then what time can I come in?
26. What is a 5 panel and what is a 10 panel?
27. What is a “in-house” UDS and what is a “send out” UDS?
28. What is a DER?
29. What is a MRO?
30
. Do I need to fill out an account set up if we have a TPA?
31. What if our Company has their own MRO and Lab, can your clinic still do the collection?
32. Can our company be billed for the collection?
1. What exactly is an urgent care center?
Urgent care centers provide treatment for the non-life threatening illnesses and injuries that occur on a day-to-day basis. They are equipped to serve the entire family including children and can handle a variety of conditions ranging from sinusitis and pneumonia to lacerations and fractures. Generally, urgent care centers are open seven days a week with hours extending into the evening. Additionally, patients seeking medical attention or advice do not have to make appointments at urgent care centers.
2. Should I visit an Emergency Room or an Urgent Care?
This is one of the most difficult questions to answer.
Urgent care
If you need care quickly and have a minor illness or injury an Urgent Care center might be a good choice. It is likely that you won’t wait as long as at the Emergency Room and your out-of-pocket expenses will also be considerably less.
Emergency Room
Emergency Rooms are appropriate when the situation is serious or life threatening. At the Emergency Room, true emergencies take priority. If you go to the ER without a true emergency, this may mean waiting a long while there before you are seen. Care at an ER will also be more expensive. If a situation is life threatening call 911.
The lists below offer some guidance to what sort of treatment each type facilitates.
URGENT CARE:
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EMERGENCY ROOM:
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3. When should I visit my Primary Care Physician as opposed to an Urgent Care?
Urgent Care Centers can present a convenient option when your regular Doctor’s office is closed such as on Weekends or Holidays. We are also available when you need care quickly and cannot wait to see your family physician. We will work closely with your Physicians office to develop the proper plan of treatment.
4. Should I call my family physician first? Yes. Your primary care physician can direct you to either urgent care or the emergency room depending on your medical condition. In the event that you do not have a family physician, you are always welcome at HCUC and MFMEC. The physician on staff will take care of your immediate needs then refer you back to your primary care physician for follow-up care.
5. What information should I bring with me when I come to the Urgent care facility?
Always remember to bring your most up-to-date insurance card and your photo ID with you to your urgent care visit. Let us know about any allergies and your medical history and bring a list of current medications. If possible, ask a family member or friend to accompany you.
4. Do you take appointments?
No. Urgent Care visits patients are seen in order of severity. In other words, people who appear to be sicker are seen sooner. If there are many people who are equally ill, then they are seen in the order of arrival. Waiting time is typically less than 20 minutes.
5. What is the wait time at HCUC and MFMEC?
Unlike most emergency rooms where it may take hours to be seen, wait times at HCUC and MFMEC are typically 20-30 minutes and may be even less. However like the emergency room, all patients are seen on a walk-in basis and the volume is variable. At times waits can be longer, but never to the magnitude of the waits in the emergency rooms.
6. What information should I bring with me when I come to the Urgent care facility?
Always remember to bring your most up-to-date insurance card and your photo ID with you to your urgent care visit. Let us know about any allergies and your medical history and bring a list of current medications. If possible, ask a family member or friend to accompany you.
7. What are your hours of Operation?
Hill Country Urgent Care is open from 9 AM to 7:30 PM M-F, 9 AM- 8 PM on Saturday and 12 Noon to 6 PM on Sunday. Marble Falls Minor Emergency is open 8:00 AM to 7:30 PM Monday thru Friday, 9 AM to 8:00 PM on Saturday and 12 Noon – 6 PM on Sunday. It is likely that these hours will be expanding soon. Please see the home page for each site for most up to date hours ( MFMEC Home / HCUC Home).
Hours are rarely changed on short notice do to unforeseen circumstances (most commonly severe weather). Please contact the clinic to confirm hours.
Both clinics are open 361 days a year, with scheduled closures for Christmas, New Years, Easter, and Thanksgiving.
Facility and Staff
8. How qualified are the physicians at HCUC and MFMEC?
We staff with the best trained and most experienced physicians possible at both of our sites. Our physicians are all Board Certified in either Emergency Medicine or a Family Medicine. Our physicians maintain multiple advanced life support and trauma certifications and maintain rigorous criteria for continuing medical education. Our medical director holds two specialty board certifications, is a Certified Medical Review Officer and is completing certification as an Aerospace Medical Examiner.
9. What does it mean when my doctor is Board Certified in Urgent Care Medicine?
The intent of the certification process is to provide assurance to the public that a certified medical specialist has successfully completed an approved educational program and an evaluation, including an examination designed to assess the knowledge, experience and skills requisite to the provision of high quality patient care in the specialty of Urgent Care Medicine. Board certification in Urgent Care Medicine is based on the review and analysis of the current state of clinical knowledge in the field of Urgent Care Medicine as it is reflected in medical literature and the acute care setting. In order to be admitted the urgent care certification process, physician candidates must meet rigorous educational and experienced-based requirements, then pass a psychometrically validated exam which is both medically and legally defensible
10. What about the other staff at HCUC and MFMEC?
HCUC and MFMEC only uses Registered Nurses and highly experienced Urgent Care and Emergency Room Physicians. Other urgent care centers use physician assistants in place of physicians and medical assistants instead of real licensed nurses. We believe that highly trained and experienced health professionals are better able to recognize and treat serious disease and injuries. We also use licensed Radiology Technicians for operation of not only our CT Scanner, but also our Computed Radiology equipment that we use for routine x-rays.
Financial / Insurance Questions
11. What insurances do you take?
HCUC & MFMEC take most PPO’s, traditional Medicare, fee for service Medicare, and Workers Compensation, HMO Blue, Humana HMO, and Superior CHIPS. However the patient must pay their portion of responsibility at the time of service, including unmet deductibles, co-pays and co-insurance. We do not take any Medicaid or other CHIPS insurance. See our Insurance Page for a complete list of the plans that we participate with.
12. What forms of payment do you take?
We accept most forms of payment including, cash, personal check, MasterCard, Visa, American Express, Discovery Card, and travelers checks. We cannot take most business checks as they will not process thru our check verification system.
13. Who do I contact with Billing Questions?
Most questions should be made to Reina McDaniel, our Senior Patient Account Supervisor. If you have a simple question regarding amounts or dates of service or need a copy of invoices or charges, the Front Office staff at either of our facilities can help you with that.
Front Office:
e-mail: frontoffice@mfmec.com
Bee Cave 512-263-1600
Marble Falls 830-798-1122
Reina McDaniel – Senior Patient Account Supervisor
e-mail: reina@mfmec.com
830-798-1122
Fax 830-798-1124
Texas Hills Urgent Care
1701 US Hwy 281
Marble Falls, Texas
78654
14. Why is the “After Hours” fee (CPT 99051) on my charges when I was seen during the normal operating hours of the Urgent Care Center?
The CPT code 99051 is one of several “urgent care” codes that where added for use at the request of the urgent care industry approximately 6 years ago. For some insurance companies, the use of the codes is restricted to use only in true urgent care practices such as Hill Country Urgent Care and Marble Falls Minor Emergency Center. Some insurance do support the use of some Urgent Care Codes at other physician offices (including primary care) under appropriate circumstances.
The CPT description of this code as “after hours” is confusing. . The insurance industry and the AMA has specified that this code is to be used when patients are seen outside of the hours of 8-5 Monday thru Friday and when patients are seen on official federal holidays (M.L. King Day, Memorial Day, Labor Day, etc) in addition to the regular office visit codes (99201-99205 for new patients and 99211-99215 for established patients). In all cases, the code 99051 does not refer to the posted hours of operation, but instead refers to patients seen outside of the customary office hours described above.
15. Why does the urgent care use these “add on” urgent codes when my primary care physician does not?
The primary reason that these codes where first used in Urgent Care Centers is that the cost to provide services to patients in an urgent care setting is higher than at other types of outpatient medical practices (family doctor, pediatric, internal medicine practices etc.) This additional cost of providing these services in an urgent care setting was acknowledged by insurance companies and is why they have agreed and even stipulated the proper use of these codes in how they process claims from urgent care providers. The insurance companies recognize that even with the slightly increased cost of providing services in an urgent care setting that the cost are still only a small fraction of the cost incurred (for both them and the patient) when one of their insured goes to the hospital emergency room.
Due to increasing practice cost and declining reimbursements, some primary care physicians now have after hours clinics frequently seeing walk in patients and those that could not come in sooner due to time conflicts. Some insurances do support the use of some Urgent Care Codes at other physician offices (including primary care) under appropriate circumstances. Understandably, most primary care physicians are now also utilizing these codes when providing these convienent "after-hours" services.
16. What other "add on" urgent care codes might I see on my bill?
It somewhat depends on your insurance. One of the codes that you might see include 99050 and 99053, which are currently used exclusively by Blue Cross / Blue Shield. These two codes are only allowed to be used by true Urgent Care Centers and are time based codes based on the physician’s time involved in caring for the patient. These were added by BC/BS in order to try to grow it's network of Urgent Care providers with the realization that there where some additional cost to treat patients in the urgent care setting compared to traditional doctors offices and in hopes of avoiding unnecessary Emergency Room visits.
99058 is another code add on code. This one is used differently by the various insurance companies. BCBS uses it as another time based code for visits that require more than 45 minutes of the physicians time. The code is generally otherwise used as an "Emergency" or severity code. In this case it is to be used when patients presents with conditions that pose a threat to "life of limb". Cigna uses this code with some Urgent Care Centers as a “global” urgent care charge.
17. Does my insurance "cover" the "add on" urgent care codes?
Yes, these codes are "covered" by insurance. However like all charges that are encountered in delivery of health services, this does not mean that you will not be responsible for paying for it. If you have not met your annual deductible, it is possible that you will be responsible for paying (out of your pocket) not only the "add on" code expense but also other expenses associated with your visit.
On some plans, the "add on" codes are covered under your office visit co-pay, but not always. Sometimes it is impossible for urgent care centers to determine in advance if the "add on" code for your visit will be covered under the co-pay or will be applied to your deductible. Under this circumstance, you may be asked to pay the add on code at the time of your visit. If your insurance company latter covers in under your co-pay instead of your deductible, you will receive a prompt refund.
Increasingly insurance companies are shifting the expense for "covered services" to the insured by applying them to your deductible. This is in an effort to keep down insurance premiums. Once your deductible for the year has been met, the insurance company picks up a larger portion of your expenses (usually 80%). It is not unusual for one of our patients to be seen one year and most of their visit is covered under their co-pay and then them to return the next year with the "same" insurance and most of their visit is applied to their deductible by their insurance.
18. Does an Urgent Care visit cost more than a visit with my primary care physician?
The office charge is about the same as a visit to your regular doctor. There is an often an additional "after-hours" charge for urgent care visits, and most health insurance covers this charge. Depending on your insurance provider, you may be responsible for the entire charge. For questions about your coverage, please contact your insurance provider. While your co-pay may be higher than that for a regular office visit, it's usually lower than the co-pay for a visit to the emergency room.
19. Why is the cost of care higher at an Urgent Care Center compared to my regular doctor’s office?
The reason that the cost is slightly higher to provide care in an urgent care setting verses a doctor’s office is multifactorial. First, the level of training and the salaries of the staff are significantly higher. In doctors’ offices, generally the “nurse” is a medical assistant that is paid in the range of $10-14 an hour, while in urgent care the nurse is usually a licensed nurse. In our case, like many other urgent care centers, we only use experienced and well trained Registered Nurses, who are paid in the range of $25-35 an hour. Also licensed Radiology Technologists, who earn $17-22 / an hour, are used in place of on the job trained medical assistants to take x-rays as is allowed in many states. Our doctors are also either Board Certified in Emergency Medicine or are Board Certified in a primary care specialty with extensive experience in Emergency Medicine, Urgent Care Medicine or both. The use of these highly trained individuals makes it safer to care for the broad range of patients and ailments that are seen in an urgent care setting. However, the cost per hour of staffing an Urgent Care Center is considerably more than a doctor’s office.
Secondly, operation of an Urgent Care Center so that it is available to see patients on an immediate walk in basis is inherently less efficient than a physician’s office. While doctors office’s have scheduled patients that come in at intervals (appointments) that allows them to staff for a certain patient flow in a cost efficient manner, urgent care centers do not have a scheduled work load. The patient work load is unpredictable. While at times the staff may have difficulty keeping up with the rush of patients that all show up at once, at other times the staff is sitting idle while still being paid their salaries. Although we do see a few follow-ups in urgent care, scheduling significant numbers of patients is not an option in an urgent care practice do to the need for the staff to be available for patients that walk in.
Also, urgent care practices are open 7 days a week, in other words the lights, the x-ray machines, and all the other equipment is powered up from 75 – 90 hours a week depending on the urgent care center (some are open even more than that). These expenses also add to the small inherent increased cost of operation of urgent care centers compared to a traditional doctor’s office.
20. If Urgent Care cost more than my doctor’s office, why should I use an Urgent Care Center?
Urgent Care Centers are never intended to take the place of your primary care doctor’s office. Your first choice for care should always be with your primary care doctor when it is feasible. Urgent Care Centers are designed to be a convenient option when your physician is not able to see you for whatever reason (can’t miss work / school, to long to schedule, not able to take care of the problem in the doctor office) and to prevent unnecessary visits to a hospital emergency room. In spite of the extra cost compared to a regular doctor’s office, urgent care centers provide a valuable service that is considerably more cost and time efficient than the alternative of an emergency room.
Recent comparison studies now put the cost of equivalent services delivered in an urgent care setting at 1/3 to 1/5 the cost of equivalent services delivered in a hospital emergency room. Urgent care will probably never be as inexpensive as a physician’s private office, nor should it ever cost as much as the emergency room. Our role in urgent care is to be the middle guy, that can do most everything that the emergency room does, but with significant cost savings. We are not designed to replace the cost effective private physician’s office which should always be the first choice for people. We all know that sometimes it is just not possible to wait or get in during normal business hours. We are here to prevent your need to go to the hospital emergency room when you cannot see your regular physician.
21. Do some Urgent Care Centers cost more than others? Does HCUC and MFMEC cost more or less than other urgent care centers?
Because of the uniformity of insurance contracts and negotiated prices for the same service, if you are using insurance, the price to obtain urgent care services is going to be pretty much the same no matter where you go. Also, if you are using insurance it is usually advantageous to use an urgent care center that is in your insurance network. Some urgent care centers like Hill Country Urgent Care and Marble Falls Minor Emergency offer significant discounts (25%) to those who find themselves being seen for treatment out of their primary insurance network. Often this 25% discount makes the out of pocket cost less that what patients would have had if they had been seen in network at another urgent care and much, much ($$$$) less than if they had gone to a hospital emergency room.
If you are paying list price for urgent care services without the advantage of pre-negotiated insurance discounts, it is true that there is some variation in the fees charged at various urgent care centers. Fortunately, like most centers HCUC and MFMEC are very close to the middle of the pack with their fee schedules. Consumers should be aware that there are some outliers that are on the extremes of pricing including some so called "urgent care' facilities in the Austin and Dallas metro area that bill like a hospital emergency room with much higher fees for the same services as other true urgent care centers. These so called “urgent care” facilities are usually, but not always, associated with a large hospital system. In this case the fees for services are usually 3-5 times the amount that it would cost at a true urgent care center. BE CARFULL !!
HCUC and MFMEC offer a 25% discount on services for those that do not have insurance. With these discounts HCUC and MFMEC have some of the lowest prices for cash paying patients anywhere for urgent care services
22. Can I just come in for a Drug Screen and how much does it cost? Yes, you can just come in and have a drug screen done without an order from an employer or a doctor. The cost is $65 for a 5 panel and $77 for a 10 panel.
23. Do you make appointment for Drug Screens and then what time can I come in? No appointments are necessary. Mon-Fri 8-4:30, Sat 9-5:00, and Sunday 12-3:00.
24. What is a 5 panel and what is a 10 panel? This is the number of drugs that are tested on each drug screen.
25. What is a “in-house” UDS and what is a “send out” UDS? An “in-house” drug screen is when it is done right after collection and if it is a clear negative, results can be given that day. “Send out” is when the collection is done and urine is sent off to another lab for processing. This may take 2 days to 4 days for a result.
26. What is a DER? DER stands for Designated Employer Representative and is the only person at the place of business that is authorized to receive the results of a drug test.
27. What is a MRO? "MRO" is the designation of an individual who has a vital role in the overall drug-testing process. "MRO" refers to a "Medical Review Officer" who in all cases must be a "MD" (medical doctor). The MRO helps protect both the rights of the employee being tested and the employer requiring the testing.
MRO "reviews" include the interpretation of urinalysis test results reported by the testing lab to ensure a scientifically valid result. Especially, the MRO attempts to determine whether a legitimate medical explanation could account for any "confirmed positive" result reported by the laboratory. This duty is fulfilled through telephone or in-person interview with the specimen donor and by giving the the donor an opportunity - through their doctor or pharmacist - to provide evidence of legally-prescribed drug-use that may have caused the lab-positive.
When the MRO can determine that a legitimate medical explanation exists, the MRO will then "overturn" the results reported by the lab and, instead, report the "final" result to the donor's employer as "negative". While a small percentage of companies will not pay the extra expense associated with MRO services, such services do greatly enhance the validity and reliability of the overall drug-testing process. They also help ensure fairness to the donor and offer more protection to the employer in any case of later litigation due to a "positive" drug test where the employee has been suspended or fired.
28. Do I need to fill out an “Account Set Up” if we have a TPA? Either the company may fill out the “account set up” or the TPA can. Usually the company responsible for paying the invoice fills out the form.
29. What if our Company has their own MRO and Lab, can your clinic still do the collection? Yes, there will be a collection fee for just the collection.
30. Can our company be billed for the collection? Yes, with the clinic account set up form filled out and faxed to back.