Choosing the Right Emergency Department Billing Services for Your Hospital

It’s no wonder that Emergency Department billing can be as chaotic as the high-pressure environment that dominates emergency rooms. You can’t predict patient volumes, and you’re constantly dealing with high-acuity cases. To add to the uncertainty, emergency physicians must treat patients based on symptoms, instead of a rock-solid diagnosis. On top of that, patients can lack insurance coverage, and ED insurance claims face a high rejection rate.

Against this background, how can your Emergency Department get properly reimbursed while delivering quality clinical care? Let’s talk about it.

What is Emergency Department billing?🔗

Emergency Department billing involves obtaining reimbursement for the delivery of emergency services from healthcare insurance payers. To comply, billers must assign and submit codes for services rendered in an ED.

Here are the steps involved in Emergency Department billing:

• Evaluation and Management (E/M) Codes:ED services are billed using a specific set of E/M codes (99281-99285) that represent the level of care provided.
• CPT Codes:These E/M codes are part of the Current Procedural Terminology (CPT) system, a standardized coding system that healthcare providers use to report medical services and procedures.
• Coding Guidelines:Hospitals follow guidelines from organizations such as the American College of Emergency Physicians (ACEP) to determine the appropriate ER visit level and coding.
• Facility Fees: In addition to the services that the ED physician provides, a facility fee is often charged for using the ED resources, including the building, staff, and supplies.
• Separate Billing:Patients may receive separate bills from the hospital (for the facility fee) and the physician (for their services).
• ER Visit Levels:Hospitals typically assign an ER visit level (1-5) based on the treatment’s complexity, which influences the charges.
• Payment Models: Because of its unscheduled nature, emergency medicine mostly operates under modified fee-for-service arrangements.

Why do ER doctors bill often separately? It’s because sometimes they’re independent contractors or employed by a separate physician staffing company, not direct employees of the hospital. Since they negotiate their own contracts with insurance companies, this results in separate bills for their services.

Key Emergency Department billing challenges to overcome🔗

The unique emergency department billing challenges originate from the fast-paced, high-pressure environment inside emergency rooms, complex cases, and the crucial need for accurate documentation. These factors easily lead to coding errors, claim denials, and compliance issues.

Accurate coding and documentation are crucial for Emergency Department billing:

• EDs see a wide range of patients, from minor injuries to life-threatening conditions, and these high-acuity cases require coders to accurately select codes for each case.
• The fast-paced nature of emergency care often limits the time available for thorough documentation, and this time constraint can result in incomplete or inaccurate notes. Documentation must be completed promptly.
• Initial assessments may lack definitive diagnoses, and this incomplete information makes it difficult to select the appropriate codes.
• Coding guidelines and payer requirements are constantly changing, and you need to keep up with them.

High patient volume and the acuity of cases presented adds more complexity to emergency department billing:

• There’s unpredictable patient flow; EDs experience surges in patient volume, making it difficult to manage workloads and deliver timely documentation.
• There’s also a constant inflow of high acuity cases; EDs often deal with patients with complex medical conditions, requiring specialized knowledge and coding skills.
• Boarding patients in the ED due to a lack of available beds only places more stress on emergency rooms.

Emergency department billing also faces insurance and reimbursement issues:

• Verifying patient insurance information and eligibility can be time-consuming and challenging, especially in a high-pressure environment.
• Inaccurate coding, incomplete documentation, or lack of medical necessity can lead to claim denials, requiring appeals and additional work.
• Managing claims from different insurance companies and payers can be complex.
• Inaccurate or incomplete claims can lead to delays in payment, impacting the ED's revenue cycle.
• Payers may deny claims if they determine that the services provided weren’t medically necessary.
  

What to look for in an Emergency Department billing & RCM provider🔗

When choosing an Emergency Department billing & RCM provider, here’s a checklist of things to look for:

1. Does the company have a proven track record and expertise specifically in Emergency Department billing?
2. Is it proficient in CPT and ICD-10 coding, especially for ED services, since these codes are complex and constantly evolving?
3. Does it emphasize the importance of accurate and complete documentation, since it's crucial for successful Emergency Department billing?
4. Does it offer advanced technology and automation, combined with human expertise, to speed up processes?
5. Is it up to date on all relevant healthcare regulations and compliance requirements?
6. Is it committed to HIPAA regulations to handle protected health information (PHI) securely and confidentially?
7. Does it have robust security measures in place to protect patient data from breaches and unauthorized access?
8. Will its billing software integrate seamlessly with your electronic health record (EHR) system?
9. Does it provide robust reporting and analytics capabilities to track performance and identify areas for improvement?
10. Is it readily available to answer questions, address concerns, and provide timely support?
11. Does it provide regular updates on the status of claims and collections?
12. Can you understand its fee structure, including any hidden costs or additional charges? Is its pricing transparent and competitive?
13. What’s the potential return on investment (ROI) for its services, considering the time saved, increased collections, and reduced billing errors?
14. Can it manage the entire revenue cycle, from claims submission to collections, to maximize reimbursement?
15. Does it offer training and educational resources to help your staff understand Emergency Department billingprocesses and coding guidelines?
16. Is it proficient in submitting claims electronically and managing denials efficiently?
17. Since Emergency Department billingcan be time-sensitive, can the company process claims quickly and accurately?
18. Since ED cases can be complex, does it have the expertise in coding and billing for various diagnoses and procedures?
    

Medusind has the experience you need🔗

Let Medusind help with your Emergency Department billing by seamlessly integrating our end-to-end revenue cycle management solution. We have over 20 years of specialized experience with Emergency Department billing, dealing with the strictures of insurance company claims submission requirements; we understand each insurer's unique criteria.

Consider partnering with a national leader in medical billing and collections. If you contact us, one of our Emergency Department billing experts would be happy to demonstrate how we can stabilize your ED’s financial health and fine-tune it to peak perfection.