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Emergency Room Billing & Coding Services

Healthcare sector is continuously evolving. Every specialty is vast and demands attention to ensure a consistent cash flow and avoid denials. One such specialty is Emergency Room. Emergency medical services have a unique nature which makes the billing process complex and challenging.

With the passage of time, it has been observed that the collection of payment is becoming more complex for emergency room and urgent care providers. This is because of the increasing number of payers. This results in the diminishing scope of payable charges.

Emergency room billing is quite different from other specialties of healthcare. Emergency Room (ER) services rise as a saviour for medical conditions that demands quick action like sudden illness. It is obvious that treating patients in such a scenario becomes the first priority of Emergency Departments (ED). However, the sad part is that many of them fail to understand the importance of carrying out coding and billing process.


What is Emergency Room Medical Billing?

For healthcare organizations and physicians, Emergency room medical billing is considered one of the most critical challenges. It includes the claims processing of different medical process that are executed by a physician to different payers. As soon as there is any minor error in insurance claims and medical bills, it can result in claim denials. These claim denials and rejections adversely impact the cash flow and profit of a healthcare practice.

It is the need of an hour to outsource the task of emergency room medical billing to a proficient medical billing organization like Eminence RCM. This will help to bypass unnecessary stress that is linked with the criticality of emergency room medical billing services.

If you are someone providing emergency room services, you must be aware that medical claims are of utmost importance. When there are rejected in any case, it puts financial constraints on your revenue cycle. One thing to consider is that the administrative work of an emergency room is different from other healthcare facilities


Let’s Discuss the Top Challenges in Emergency Room Medical Billing

Maintaining Compliance Standards

The most complex challenge in Emergency room medical billing is related to the privacy breaches. There are various threats to patients’ critical information. And it needs to be protected by healthcare providers at any cost. The emergency room need to work along with the Healthcare Information Portability and Accountability Act 1996 (HIPAA). If there are any frauds in healthcare and abuse of laws, it may result in penalties and severely affect your medical practice.

As per HIPAA, the following things are mandatory –

  • Standardization of the medical codes
  • A regular compliance audits
  • Foolproof workstations
  • Electronic filing of medical claims
  • Restricted access control to medical records
  • Password Protected Access to the Software

Proper Coding and Billing

Coding and Billing are the areas where emergency room practice needs to thrive at any cost. If the entire billing and coding process is carried out correctly and timely, it results in the establishment of a smooth revenue cycle. Emergency medical billing and coding demands undivided attention and caution as it is directly related to the income of a healthcare practice. However, the reality is quite the different and opposite. As per the report of National health insurer report, about 20% of the claims are incorrectly paid. This means that the healthcare organizations have to suffer losses of about 4%-12% of their total entitled reimbursement.

Consistent Cash Flow

American Medical Association (AMA) stated that more than 10% of claims are not paid accurately. When there is a consistent cash flow, it means the good financial health of an emergency room. And if the accounts receivables are strong, you don’t have to worry about the entire revenue cycle. You need quick measures to increase the collections and boost the cash flow for a consistent revenue in your healthcare practice.

Denials and Appeals

Emergency Room face denials and appeals for the claims that are submitted without proper scrutiny. In case a claim is denied, the foremost thing to do for the healthcare provider is to investigate the reason for the denial. On the basis of that the appropriate course of action is determined. There might be a situation where the provider may need to submit additional documentation or appeal the claim to get reimbursed. Common reasons of claim denial reasons for emergency rooms includes, lack of medical necessity, missing/ incomplete information, patient’s pre-existing conditions, exceeding policy limits, not taking prior authorization, documentation errors, and many more.


Tips to Ensure a Smooth Revenue Cycle for Your Emergency Room

Proper Documentation

Is essential to support your medical billing and coding with accurate documentation, if you want it to be successful. A qualified medical billing expert like – Eminence RCM is a must to ensure close examination of documents while you are examining patients. It is vital to accurately document the patient’s condition, medical necessity, procedure, treatment, and medical procedure performed during the visit of the patient. The documentation should properly support the service that is billed and comply appropriately with the regulatory guidelines of CPT HIPAA.

Timely Filling the Claims

For the ER, timely submission of claims matters the most. There are specified requirements by insurance companies for emergency claim submission. You especially need to take care of the time limits. This is the reason why you need to pay special attention to the deadline of the submission. Be vigilant and submit the claim on a timely basis to avoid the risk of claim denial and delay in reimbursements.

ER Modifiers

Another important point to consider is to always pay attention to specific modifiers in the emergency room. They vary according to special circumstances. Use special modifiers to indicate exceptional circumstances, if patient is in ambulance. After that, ensure to make a bill using modifiers and protect your healthcare practice from potential claim denials.

There is a growing strain for the hospital to provide indigent care, and remaining financially afloat becomes critical under such circumstances. This results in many hospitals becoming overcrowded and ultimately closing. However, if the insurance covers all the patients and the medical billing and coding process is carried out diligently, it can significantly improve the revenue cycle.

Moreover, with the appropriate use of emergency room codes and modifiers in medical billing and coding, it is guaranteed that the healthcare practice will work in the interest of everyone. For that you need an expert medical billing services provider like Eminence RCM to handle your medical bills while you impart the expert healthcare services to the patients.

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