Challenges & Solutions to Emergency Room Medical Billing Services

Emergency Room - ER services are helping the patients with medical conditions that require quick attention, say an injury or sudden illness. Comprehensive charting is important for emergency room medical billing as it can make the whole process less likely to be exposed to critical challenges and risks. However, according to an article published in HFMA, at most ERs across the country, a huge opportunity is seen in improving care, minimize risks, and improve the revenue cycle by focusing on documentation practices.

The emergency room documentation serves many purposes. Along with being used to justify reimbursement from insurance companies, ER documentation is helpful for providers of what was done for the patient. The details may consist of diagnostic tests, medical decision making and treatments, communication with patients and relevant families, consultant recommendations, patient follow-ups, and many other details of the encounter. The emergency documentation record also helps as a defence in cases of a lawsuit. Moreover, ED charts are referred for quality improvement, research purposes, and utilization/risk management. In short, the ED chart should be complete, accurate, concise, and organized.

If you are handling your emergency room medical billing services, you must be aware that medical claims are so important and how they can put financial constraints in your revenue cycle when rejected. The administrative work of an emergency room is different from other common healthcare facilities as clinical treatment is always shorter and prone to emergency procedures, starting from a patient's appointment to account closure.

Here are top challenges and solutions in emergency room medical billing services

Compliance Standards

Privacy breaches are the main threats to patients' critical information. It needs to be protected. The revenue cycle management systems of the emergency room need to work along with the Healthcare Information Portability and Accountability Act 1996 (HIPAA). Frauds in healthcare and abuse of laws may result in penalties and severely affect your medical practice. HIPAA mandates -

• Standardization of the medical codes
• A regular compliance audit of the facility
• Electronic filing of medical claims
• Foolproof workstations
• Restricted access control to medical records and access only on a needed basis
• Password Protected Access to the Software and Online Coding Software

Solution: Complying with the HIPAA and honestly sticking to the mandated protocols and guidelines can safeguard the privacy, security, and confidentiality of protected health information (PHI).

Coding and Billing

This is an actual part where emergency room practice needs to thrive. If done correctly and timely, it can establish a smooth revenue cycle. Emergency medical billing and coding needs extreme caution as it is directly related to a practice's income. But, the actual events are different. As per the National health insurer report, about 20% of the claims are incorrectly paid and the healthcare organizations have to suffer losses for around 4%-12% of their total entitled money.

Solution: To recover the designated amount, your emergency room practice must use well-credited medical coders and billers experts in denial resolution, claim follow-up, claim appeal submission, bill adjustments, etc. You can also work in sync with an expert agency that has expertise in the ICD-10 & ICD 11 coding systems. This is a great way to safeguard a positive cash flow in your organization, which will boost your revenue cycle.

Interoperability

Information and Communication Technology have helped practices save time and costs by expediting the exchange of information between multiple healthcare scenarios. Physicians at the emergency rooms can have access to their patient's data and integrate this data with other records in no time. Therefore, interoperability, an ability of IT systems and applications to communicate and exchange information are still unreached.

These legacy systems are still functioning in the hospitals because they have autonomous nature, which has various modules and nomenclature for multiple processes and procedures make interoperability unapproachable.

Solution: You can easily achieve interoperability if you adopt a standardized healthcare terminology, strategy, and usable interface of ICT tools. Moreover, with continuous changes and updates in the medical regulations, interoperability can serve as a tool to eliminate data exchange problems across doctors, hospitals, labs, patients, and pharmacies to a large extent.

Maintaining a Consistent Cash Flow

American Medical Association (AMA) says that more than 10% of claims are paid inaccurately. A consistent cash flow means the good financial health of an emergency room. And if the accounts receivables are strong, you don't have to worry. OR, you need quick measures to increase the collections and boost the cash flow.

Solution: You can identify the important elements of the emergency room revenue cycle and collaborate with an expert medical billing agency.

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Read more: Medical Billing Guidelines For Emergency Medical Billing Services