Emergency medical billing is a distinct part of healthcare billing. It is, however, treated as a separate entity because it involves high value dollar and involves a lot of careful and even complex considerations. This makes emergency physician billing services very critical. Most large hospitals have a separate billing section to manage this.
There are multiple challenges associated with emergency room medical billing. The biggest challenge is processing claims for different medical procedures of varying level of complex medical conditions. A very minute error in coding and billing can result in claims delay if not denials. The impact of this can be huge as it involves high-value cash flow.
| In the year 2020, the number of emergency department visits in the United States rose from 139 million to 500 million because of the pandemic. The sudden spike in numbers made errors rampant. This was not just because of numbers but also constant change in billing rules triggered by the pandemic. Hospitals had to put up with huge losses. |
The one thing that came out of the last two years of the pandemic is that emergency physician billing services must be more prepared than other kinds of healthcare billing to scale at any point of time and even by manifold rise. This is possible only if hospitals partner with the right vendors with considerable expertise in emergency room billing. These partners will help you take the stress of financial performance off your plate by executing the task with the expertise with which it needs to be done. A lot however depends on the type of partner you choose to work with.
Primary Challenges Associated with Emergency Physicians Billing Services
ED Documentation
Maintaining accurate and proper emergency room documentation is a constant challenge. This is because emergency departments are a lot busier than other care departments. The biggest challenge is in not having dedicated people for regular charting will restrict timely and accurate documentation.
There is a clear distinction between ED notes and notes of other care providers. Every patient interaction in ED has to be directed as a new patient interaction. This makes it mandatory to record past, present, and future medical details of the patient
There is also a difference in ranking or coding the notes. Charts are ranked entirely on the complexity level of the patient. The level tends to range from 1-5. This is to show the criticality of care provided and the kind of resources and equipment provided to a patient.
ED charting also requires a basic documentation to meet the billing criterion. The documentation of low acuity cases is represented by lower codes which again increases with complexity.
Another problem with emergency physician billing services is upcoding and down coding. It happens mostly because of inadvertent errors. For instance, emergency room visits with level 4 or 5 complexity have a high chance of the claims declined or pared down if payers find that it does not fulfil a high-level code. This is because of the high value costs involved. Therefore, involvement of the physician in documenting or approving acute patients is a must but is ideally not possible.
One common reason for errors is a mismatch between internal EHR and emergency room documentation. Inconsistencies can lead to revenue loss besides exposing practices to medico-legal risks. This is why there has to be a proper way to monitor charts and ensure timely flagging of issues by practice managers.
Emergency medical billing documentation once done cannot be amended at will. Most such modifications are viewed with suspicion. This can lead to a denial of coverage or even lead to fraud charge.
Issues Due Insurance Verification
This happens because of an error in front office desk. Emergency medical billing will have to bear the brunt of improper or invalid insurance-related information. There have been many instances of major verification issues bypassing the front desk and moving to the emergency department. This has invariably culminated in a denial. Therefore, it makes perfect sense to have proper communication between front office desk and emergency room billing. This will help share updated and revised information to the emergency room and would bring about consistency to the documentation process.
Ways To Improve Emergency Physicians Billing Services
Proper Checks and Measures to Prevent Down coding and Upcoding
Healthcare providers need to have a proper way to counter emergency medical billing down coding or upcoding. This is a strategic imperative for maintaining financial stability. The best way to achieve this is by improving clinical documentation with multi-tier quality checks, continuous training and regular internal audits. The coding departments must be segment based on severity of cases. Yet another way is to have a uniform policy for clinical treatment.
Modifying Electronic Health Record (EHR) Templates Based on Disease and Severity
The documentation interface of an EHR can be modified to include “dot phrases” or abbreviations used in medical documentation. This will help to automatically pull out the exact template for patient treatment in emergency rooms. An unresponsive patient for instance would require a different template compared to one treated for a minor trauma. Likewise, voice dictations can help take direct notes from physicians and get them converted to texts.
Maintain Strict Standards with Medical Records Access and Amends
Changes made to EHR documentation must be done as per the applicable rules. HIPAA requires patient records to be accessed by appropriate personnel and only when there is an absolute need. Therefore, every kind of documentation and rectification must be done immediately. The need for an amend, must be accompanied with a proper and rule-based justification.
Do the Necessary Before Treating or Discharging Patients
The emergency room treatment must include a proper way to discharge patients with the right instructions and stating when the individual should return to seek care. This includes proper transitioning of patients to another level of recommended care. Due attention must be given to highlight the level of care provided to handle the patient’s condition. A proper round-off of the documentation ensures the claims happen in full.
Conclusion
The importance of emergency physicians billing services is not just to ensure there is no claims denial. The objective should be to make sure that you are also fully compliant with all HIPAA requirements. If these two aspects are included in your objectives, it can assist you enhance reimbursement from emergency treatment in the right way
Who We Are and What Makes Us an Expert?
This article is brought to you by Medbilling Experts an expert provider of healthcare back-office services. One of the services we specialize in is emergency physicians billing services. We have a dedicated team to handle this process. Get in touch with us to know more.
