E/M Coding Alert - 2021 Issue 2
Patient Relations: Confidently Answer 4 Common Questions from ED Patients
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Article Overview
This article is aimed at emergency department billing, registration, and patient-facing staff who need clear, consistent ways to address recurring questions about hospital and physician charges, observation status, and medication coverage. It discusses Medicare outpatient observation communication, outpatient versus inpatient coverage concepts, diagnostic testing after a patient leaves before physician evaluation, and the distinction between hospital and professional billing in the ED setting.
Why This Topic Matters
Patient confusion about ED bills can lead to frustration, repeat calls, and delayed resolution. Understanding the general categories of coverage and billing issues discussed here can help staff communicate more clearly and direct patients to the right information.
Article Sections
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Medicare coverage confusion in ED observation care
Explains the type of patient questions that arise when hospital stays are not treated the way patients expect under Medicare. Introduces the communication framework used to address outpatient observation status and related notice requirements.
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When a patient leaves before physician evaluation
Covers the common scenario in which a patient receives testing but departs before seeing a physician. Describes the general distinction between physician evaluation services and hospital-reported diagnostic services in this situation.
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Medication coverage during observation stays
Addresses patient questions about drugs received while in observation care and the broader issue of prescription coverage. Notes the role of pharmacy benefits and related patient notices.
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Why hospital and ED group bills may both appear
Reviews why patients may receive separate bills from the hospital and the emergency physician group after a visit. Explains the broad difference between facility charges and professional services.
What You Will Learn
- How to frame common patient questions about emergency department billing and coverage
- How observation status and patient notices fit into patient communication
- How to explain billing when testing occurred but the patient left before physician evaluation
- How to discuss medication coverage questions during observation care
- How to distinguish hospital billing from professional billing in the ED
Who Should Read This
- Emergency department billing staff
- Patient relations teams
- Registration staff
- Revenue cycle professionals
- Emergency department managers
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