Emergency medical billing is unique compared to all other medical billings, the patient comes without any prior appointment either on an ambulance or on their own. Emergency room billing challenges are extensive because patients are admitted immediately without any insurance information. Emergency Rooms (ER) need experts of wide variety and extensive experience who can deal with emergency situations to save patients life. As per federal law especially Emergency Medical Treatment and Labor Act (EMTALA) mandates that ER doctors provide emergency care to any patient arriving at emergency room regardless of patients’ insurance status.

Legion Healthcare Solutions (LHS) deals with emergency medical billing at two levels, firstly with an insurance company and then with the patient directly. The process may further be complicated if the patient needs long-term care, where the patient’s procedure may change. Most insurance companies avoid credentialing with ER, because of variable costs related to a patient.

“When it comes to ER billing LHS has to completely be at a different level, if any third-party ambulance is bringing the patient in, we have to document that along with the initial patient condition. Most patients who arrive at ER are in subdued state which means the least information doctors get from looking at physical injury will be provided to us. However, the bigger challenge comes with AR from insurance company or patient.”

– Medical billing manager at LHS

Improving Charge Capture: Most ER make the mistake of not charging the complete amount to the payer. Most emergency departments are fast-paced in nature which is further compounded by a lack of understanding for documentation. LHS helps in documenting the complete patient procedure and even identify the not fully charged before discharge patients.

ER coders have a Dual Job: ER coders constantly go through changing scenarios of patients and even inform the doctors in ER about the patients who not fully charged before discharge. Legion billing solutions encompass this issue by training the coders and ER billing managers to identify such claims and inform the ER.

Credentialing: ER credentialing is different than other specialty-based physicians credentialing. Credentialing most specialty physicians of a region can assist the ER to get paid when patients come in. Most private insurance payers don’t include the ER under their benefit to avoid the complexity of payments. LHS, however, works with most common insurance payer of the region and reduce the out-of-pocket payment for ER and patient.

Necessitating the required Patient Care: Billing managers will be required to work with ER in providing the necessary patient care devices or facilities. Most ER service providers are unaware about the other billing guidelines, hence affecting their reimbursements.