Challenges In Emergency Room Medical Billing

It has been observed that for emergency room and urgent care providers, the collection of payment is becoming more complex owing to the increasing number of payers. As a result of which scope of the capacity of payable charges appears to be diminishing. Emergency medicine is widely different from other specialties of healthcare, specifically when there are factors like reimbursement, payer mix, and others that are responsible to strengthen the business model. Emergency Room (ER) services are blessings for medical conditions, which need quick action like sudden illness or injury. Treating patients is a primary objective of Emergency Departments (ED), however, many of them fail to understand the challenges in emergency room medical billing.

Let us understand Emergency room medical billing and its challenges:

What is Emergency Room Medical Billing?

Emergency room medical billing is considered one of the critical challenges for healthcare organizations and physicians. It encompasses the claims processing for different medical procedures executed by a physician to payers. A very minute error in insurance claims and medical bills can result in claim denials, which is expected to impact the cash flow and profit of a healthcare practice.

In the year 2017, the number of emergency department visits in the United States is about 139 million, as per the report published by the National Hospital Ambulatory Medical Care Survey. Thereby, it is the need of an hour to outsource the task of emergency room medical billing to a proficient medical billing organization that will bypass unnecessary stress linked with the criticality of emergency room medical billing services.


Concerns Regarding ED Documentation

In the case of a complaint, the ED record always acts as a shield. Moreover, ED charts are supervised for research purposes, quality enhancement, and in risk management as well as utilization. To raise a query ED chart should be proper, thorough, precise, and organized.

Regular and proper charting is complex because emergency departments are quite busier than other care departments that is why they restrict timely documentation. There are particular distinctions between notes of other care providers and ED notes which are as follows.

    • Every ED interaction has to be directed as a new patient interaction. As a result of this, the providers require to record past, present, and future medical information of the patient.
    • The attending physician meets a patient only once in the emergency department and the chart is the only place to record the visit experience that has been made.
    • Difference between other encounters and ED visits encounter
      • Ranking of ED charts are based on the complexity level that ranges from 1-5, pointing the criticality of care provided and the volume of resources allocated to a patient
      • For every level, basic documentation is necessary to fulfill billing criterion
      • Low-acuity cases are denominated by level 1 codes, on the other hand, level 4 and level 5 codes are for critical cases which need different treatments

Upcoding, as well as downcoding, are considered as issues in the documentation of ED. Emergency room visits with level 4 or 5 management and evaluation codes expected to look their claims declined or tailored downward if payers identify the claim is not capable to fulfill a high-level code. If the emergency room physician is not able to document the hard work involves in maintaining the health of acute patients there could be a difference between actual treatment given and treatment documented.

Working Problems that Impact Emergency Room Medical Billing

  • Dissimilarity in Internal EHR and Inaccurate Documentation

Missing of charts signifies medico-legal risks as well as revenue loss. A robust system for monitoring unprocessed charts that provide alerts for both practice managers and providers needs to be established.

  • The Difference in the Verification if Insurance Eligibility

Most of the time, when patients visit emergency rooms their insurance-related information is improper, not updated, and invalid. Effective and efficient insurance verification services are required in order to collect correct insurance information. The revised and updated information should be communicated to the emergency room medical billing organization.

  • Patients who Leave without Treatment (LWT)

In order to tackle this issue, you have to keep communicating with your patients regarding delays in treatments and delivering regular reassessment. Moreover, initiating treatment when the patient shows symptoms of a particular disease. In addition to this, shift wise monitoring LWT rates will also help you to resolve such kinds of issues.

As increasing importance on reporting of quality initiatives and essential measures, proper medical charting continuing to vital requirement to make sure compliance. Furthermore, to deals with these problems, emergency physicians to require to stay updated with changes in the billing rules and coding and documentation guidelines. Emergency room medical billing services are there to help physicians enhance reimbursement and ensure regulatory compliance as they concentrate on offering the best level of treatment to their patients.