Comparison of definitions for identifying urgent care centers in health insurance claims

Buttorff, Christine; Heins, Sara E.; Al-Ibrahim, Hamad

doi:10.1007/s10742-020-00224-6

Cited by 1 publication

(1 citation statement)

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“…To identify care settings, we used a combination of fields on a given claim to classify it as occurring in a particular care setting: inpatient, hospital outpatient, physician office, EDs, UCCs, and other location (the exact definitions are summarized in Appendix Table A2). Our methods for identifying UCCs are described in greater detail in a previous publication (Buttorff et al, 2020), but in summary, we classified claims as billed from a UCC if they identified in NPPES as an organizational NPI with the UCC taxonomy codes in primary or secondary position (261QE0002X; 261QU0200X) and used a place of service code of 20 (a Center for Medicare & Medicaid Services (CMS) classification of UCCs that is also used by many commercial insurers), or billed one of the UCC Health Care Common Procedure Code System codes (S0983; S9088) in at least 10% of claims. This method of identifying UCCs had a positive predictive value of 87% and identified 8,261 UCCs in NPPES, in line with industry estimates.…”

Section: Care Settingsmentioning

confidence: 99%

Changing Care Settings for Injuries

2022

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Tracking injury rates is important for surveillance purposes but little data exist for injuries outside of emergency department visits. We assess the share and type of injuries reported in urgent care centers (UCCs) compared with other settings. We used FAIR Health claims data from 2016 through the first quarter of 2019 to calculate the percent of claims and most common types of injuries. Of the 197 million injury claims, 62% occurred in office settings and 17% in hospital outpatient departments (HOPDs), 5% in inpatient and in ED settings, and less than 2% in UCCs. Injury claims in UCCs increased 6% from 2016 to 2018, whereas injury claims in EDs declined 24%. Overall, physician offices and HOPDs accounted for the largest share of injury care, but UCCs represented the fastest growing setting to treat injuries.

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Section: Care Settingsmentioning

confidence: 99%