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There are 300 kinds of services provided under Emergency Room (ER) services and a few of them are entitled to insurance reimbursement. Each procedure code has a distinct set of criteria and unless the care provider properly establishes with documentation that an emergency treatment episode meets all of them, it leads to claim rejection. Also in relation with emergency medicine, EMTALA which governs emergency services in the US mandates that emergency services be available to all regardless of ability to pay or insurance coverage.

This leaves care providers and hospitals to deal with not just an increased number of patients but also procedural complications like accurately identifying which services are eligible for reimbursement, documenting such treatment episodes accurately, and preparing and submitting claims.

It requires trained skills and understanding to meet all the requirements, especially because all these activities are not as straight forward as other specialties. For example, identifying which ER services are eligible for insurance requires medical understanding along with knowledge about necessary regulations.

Outsourcing to MBC

At MBC, we have medical billers and coders who have the right degree of sophistication to handle the complexities of ER billing. They can help you with the entire range of activities involved in an emergency medicine billing procedure, starting from accurately identifying the cases that are entitled to reimbursement and their procedure codes through documenting their qualifying criteria to preparing their claims and submitting them.

Apart from a theoretical and practical understanding of EMTALA, its implications and procedural necessities, our billing professionals’ years of experience in varied healthcare environments gives them an additional advantage; they appreciate the fact that ER service is but a part of a large treatment cycle where the activities are performed, whether administering a treatment or documenting it – form the basis of the entire administrative and medical episode, particularly in a big hospital that combines emergency as well as surgical services. This appreciation helps our emergency medicine billers and coders to function such that facilitates the advanced stages of a treatment procedure, in terms of documentation and other procedural matters.

Via MBC’s flexible emergency billing and coding services, you can choose the service model that suits your and your organization best. Our revenue cycle management (RCM) services will help you:

  • Tighten your revenue management process by replacing obsolete software applications by appropriate applications that suit your needs and smoothens the process of electronic transfer of data mandated by HIPAA
  • Streamlining your existing process by trimming out rambling procedures and processes and spotting gaps of revenue leakage and identifying training needs

By opting for MBC’s outsourced billing and coding services, you can completely ship out your administration responsibilities to us and solely concentrate on health care.

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