Assessing and Managing Emergency Department Billing Challenges, Part 1

Wednesday, January 29, 2020

When it comes to medical billing and coding, emergency rooms are often very different from other departments of a hospital. From the pace of day-to-day operations to the kinds of patients seen and frequency of visits from doctors, there are very different challenges when it comes to properly documenting emergency room visits and required payments. 

PhyCon Incorporated, Specializes only in emergency room medical billing. We help practices collect on average approximately 10-15% more than their previous billing companies, plus help you avoid costly errors. This two-part blog series will go over how ER billing and documentation practices differ from other types, plus some of the common issues that face many such departments and how you can be sure to avoid them. 

Why Emergency Room Documentation and Billing Are Vital

There are two tracks of reasoning for why ER billing and documentation areas are so vital to a practice. The first relates back to the practice’s viability – it obviously needs to collect the proper funds due based on the care provided to stay in business.

The second, however, speaks to the quality of care a practice is able to offer. In addition to justifying reimbursement from insurance companies, proper ER documentation helps categorize and store everything a patient has been through in the ER, from diagnostic tests to medical treatments, family and patient discussions on care, consultation recommendations given, follow-up appointments and numerous others. These records are vital for maintaining care levels, plus they can serve as a defense for practices in case of a lawsuit. They even play a major role in quality improvement and future research or risk management. 

How ED’s Differ from Other Departments

Generally speaking, emergency departments are busier than other care areas. This means there is less time to focus on documentation, and it also means a few other differences in the way ED notes and documentation formats are made:

  • Each ED admission is handled as a new patient encounter, plus a final patient encounter. This means the provider needs to record prior medical information, the current problem and all plans for future care, including follow-up appointments. 
  • The physician sees the patient only once in the ED rather than multiple times, meaning documentation of this single visit is vital. 
  • Billing for ED visits differs from other types – charts are ranked based on complexity of care delivered and resources required, and each level has its own set of minimum documentation requirements that must be completed for billing purposes. The higher codes signal serious conditions that require significant hands-on treatment. 

For more on how emergency departments differ from others in their billing and documentation needs, or to learn about how to manage these challenges effectively, speak to a member of the staff at PhyCon Incorporated today.