When an individual suffers from an unforeseen medical condition, the emergency room takes care of that patient. In day-to-day life, there are enough individuals who need help from an emergency room. These can be life-threatening situations as well. As a result, emergency rooms function round the clock, all days of the week and throughout the year. Understandably, emergency physicians are the busiest healthcare providers.
When treating patients is hectic enough, medical billing only adds to this burden. On the contrary, the financial posture is unavoidable and needs proper attention. A successful emergency room must have the best of both worlds, that is, satisfied patients and a streamlined administrative process.
Emergency physicians save the patients, but they need some rescuing as well in terms of medical billing.
Even though the collection of reimbursement is complex, with some assistance, healthcare providers can meet their responsibilities and fulfill administrative obligations. A workmate like emergency room medical billing services will take over the workload and ensure maximum revenue. Outsourcing is a building block for improvement in practice management and operational efficiency.
Emergency room medical billing services are a cluster of various aspects, and the first step is acquiring knowledge to deal with the challenges. This blog will give you detailed information regarding emergency room medical billing and help you make an informed decision.
We will begin with the fundamentals and move towards challenges and solutions
Emergency Room Medical Billing
Emergency room medical billing is a method of claim processing for the services rendered to patients in the emergency room. This is considered a complex task due to the challenging medical conditions. Every emergency could be different from the other and can have distinct care requirements. As the treatment is translated into medical codes to file claims, there can be a range of codes specific to every medical condition. Even minor errors in claim filing can interrupt the flow of operations and affect revenue.
Profitability is essential to continue the practice and productivity of operation activities. That is why every step in medical billing requires precision and accuracy. Drawbacks in the process can cause denials and rejections that are not in favor of the practice.
Emergency room billing services are extended by professionals with an understanding of billing and coding. Their proficiency is capable of improving revenue cycle management and generating adequate reimbursement. This is possible, as expert services offer assistance at every step of medical billing.
Challenges in Emergency Room Medical Billing
Coding Specificity
Coding is a prevalent challenge in medical billing. The reason behind this is the challenging nature and the number of patients with distinct medical conditions. Often, selecting the correct code becomes an arduous process.
A healthcare provider must be familiar with the latest CPT, ICD-10 codes, and HCPCS codes. Or you must have billers who are well-versed in these codes as this is vital to ensure accuracy in billing. The codes must be specific and align with the emergency department. Coding is also dependent on accurate documentation of diagnosis and treatments. This can simplify the challenge and ease the process.
Some other important aspects that make emergency room billing challenging are:
Restricted Time Frame:
Emergency rooms are always on the go and almost all the time they are fighting against the time to save the patients. This leaves no time for documentation and leads to an increase in the number of errors.
Complications in Cases:
The cases that emergency rooms deal with are complex as they involve multiple diagnoses, procedures, and treatments. As a result, coding needs clear and deep knowledge including understanding of all the rules and regulations. However, this can be a challenge for well-trained coders as well.
Incomplete Knowledge:
Emergencies may arise and doctors may have to render services without verifying or cross-checking insurance coverage. Treatments for incomplete information make accurate coding difficult and further affect the revenue cycle.
Ever Evolving Regulations:
Coding rules and regulations keep changing and evolving frequently. The coders must stay updated with the latest rules and guidelines to prevent errors related to such changes. Smaller practices face difficulty in staying up to date as they have limited resources.
Medical Necessity
When billing for emergency rooms, you cannot overlook medical necessity. It is a major billing challenge that healthcare providers find hard to solve. To dive deep into it we first need to understand the concept of medical necessity.
It refers to the immediate medical attention necessary for preventing serious medical conditions or even death. What makes it challenging is the need to document such situations completely and without errors. A failure to maintain accuracy in these documents hampers the billing process and restricts the financial flow.
Therefore, healthcare providers must ensure that the patient’s symptoms, examination, diagnosis, and treatment plan are carefully recorded. This challenge is very personalized, and this increases the difficulty as well.
Claim Denials and Follow-up
Just like any other branch of medicine, the emergency room medical billing process faces denial and rejection of claims. This brings the topic of carefully dealing with the claim denials. Healthcare providers must find out the reason behind the denials. This helps in determining if that claim can be corrected and resubmitted. More than half of the denied claims are eligible for correction and resubmission.
Lack of proper denial management is a valid challenge and a reason for the lost revenue. Only a proper follow-up that analyzes the claims, outlines the mistakes, and resubmits can reclaim the lost revenue.
This is useful for the future, as the process involves understanding the trends and exact reasons for mistakes. This helps in becoming proactive and preventing such denial of claims further.
As discussed, the challenges in emergency room billing are the prime reason for inconsistencies in getting adequate reimbursement. A one-stop solution for this is emergency room billing services. Outsourcing a medical billing company can have a positive impact on your practice.
Let’s find out how?
Benefits of Emergency Room Billing Services
Reduction in Errors
Professional medical billers are experts at handling the medical billing of various medical specialties. They take extra care with coding procedures and ensure zero errors in claims. All their attention is on precise recording, code allocating, and claim filing. After that, they make timely submissions allowing healthcare providers to focus on patient care.
Better Patient Care
As all the administrative responsibility is addressed by outsourcing partners, healthcare providers are free from this burden. As a result, they have stress-free time to improve patient care and offer quality services. In emergency rooms, this holds utmost importance as patients with serious medical conditions can show up anytime.
Cost Efficient
Medical billing services are a cost-efficient method as the list of expenses for healthcare practices is enormous. Your outsourcing partner is a third party that ensures completion of all the aspects of emergency room medical billing. This eliminates the need to maintain an in-house billing staff that raises the expenses. In conclusion, healthcare providers would not have to pay salaries, and spend on infrastructure. That is why choosing emergency room billing services is cost-effective as everything is managed by the billing partner.
Improvement in Cash Flow
Outsourcing eliminates the delays caused by vacation by the staff. This doesn’t happen with the outsourcing partner as they work all year round without any holidays. This creates a free-flowing cycle and claims are submitted on time. Therefore, there is an improvement in cash flow due to no delays. The claims are handled promptly, yielding better and feasible results.
Complete Reimbursement
As overall costs are reduced along with the least number of denials, the chances of receiving complete reimbursement increase by a fair rate. Adequate revenue and the least administrative costs allow the healthcare providers to invest their money in the practice and avail better equipment. In the longer run, healthcare providers can offer a wide range of services to patients.
Overall Compliance
With an outsourcing partner, you don’t have to worry about the security of patient data as they maintain complete adherence to compliance. The outsourcing partner takes care of the regulatory requirements such as Medicaid, Medicare, HIPAA compliance, and many more. As the rules and regulations keep changing, the outsourcing partner stays current to prevent errors related to the changes.
Bottom Line
Emergency room medical billing services can elevate the financial performance of the healthcare practice leading to improved revenue cycle management. If you choose to outsource your medical billing, then Unify Healthcare Services is the ultimate choice for you.
Unify Healthcare Services is one of the top-tier medical billing services in USA with solutions to every emergency room billing requirement. We have a team of professional billers and coders who understand every nuance of emergency room billing. Our services are designed to offer customized solutions to every challenge. With us, you will experience streamlined administration that leads to maximum revenue and an uplifted bottom line.
