Do you work with retail clincs?

I keep hearing about partnerships between hospitals/practices and retail clinics. But I never meet anyone who has actually been part of one.

Does your practice have any kind of cooperative arrangement with such a clinic?



Roy Edroso
Part B News


  • edited May 2017
    By "retail clinics", I assume you mean private medical practices. If so,
    then in my experience, each local market for care has its own
    characteristics in this area. My own experience is that when a health
    system or large hospital dominates a market, they engage in highly
    competitive practices vs any competitor - large or small. They leverage
    their advantages, such as non-profit status, using volunteer labor, access
    to capital via bonds and higher net-worth board members, and their relative
    power / size to glean better payer contracts.
    Please define "retail clinic".
    If you mean urgent care centers, the situation may still be as described as
    above. Strategically, the patient is one part of the process. Depending on
    the Dx, referring providers are critical as well.
    Lots of moving parts involved, so it may be challenging to generalize about
    this phenomena.
    Bob O.

  • edited May 2017
    Thanks, Bob. Sorry to be unclear – I mean minute clinics, urgent care centers, basically any clinic that operates in a mall or similar commercial environments and is staffed with NPs/MAs rather than MDs.

    I hear a lot of stories of health systems partnering with them – like this one about Walgreens and Providence Health & Services:

    But I don’t know anyone who has actually worked in this environment. How about you?

  • edited May 2017
    I worked with one of the organizations when they were trying to set up their billing. They wanted to set up a static billing system based on diagnoses only with a documentation template based on a set presenting problem. I told them again and again patients are not static and that was not an appropriate billing approach. They just didn't get it saying anything out of the "normal" would be referred to an ER. Of course that was after the pt was worked up by the retail clinic. Finally I got so frustrated trying to make them understand appropriate EM billing based on hx, exam, and decision making, I told them I could not work with them to create an inappropriate billing system. I quit the project.

  • edited May 2017
    Wow. That’s interesting. So they didn’t want to use treatment codes?

    If they didn’t, I imagine they didn’t consider the patient record portable for purposes of future patient care elsewhere?

  • Roy –

    I have not worked with any of those clinics – but I did have a very good experience with one as a patient – both in terms of the care received and the accuracy of the coding.

    I happened to need care while attending the AAPC HealthCon in Orlando last month – so I visited the Minute Clinic at the Walgreens closest to Disney. The history and exam were pertinent to the presenting problem, and while I did not actually see the documentation, the code chosen was correct for the service performed. The nurse practitioner even chose a more specific diagnosis code than the one I thought of (without my book handy), and she was right!

    Eavesdropping (couldn’t really help it while sitting just a few feet away), I did hear the Nurse Practitioner refer a patient to an ophthalmologist who agreed to see the patient immediately.


    Kim Huey, MJ, CHC, CPC, CCS-P, PCS, CPCO

    KGG Coding and Reimbursement Consulting, LLC

    PO Box 1804

    Alabaster, AL 35007

    Phone: 205/621-0966

    Toll-free: 877/893-5583

    Fax: 781/723-5558

  • edited May 2017
    They used EM codes but the LOS was preset based on the diagnosis based on a presenting problem template i.e., ear pain would create a specific template that would then equate to an EM level of service.

  • edited May 2017

  • edited May 2017
    Level of service

  • ​Level of Service LOS

    Maxine Lewis, CMM, CPC, CPC-I, CPMA, CCS-P

    Main: 513-771-7070
    Direct: 513-672-4363

    Fax: 513-326-7640

    200 Northland Blvd

    Cincinnati, OH 45246

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