Facility Reimbursement Update: 6 Areas Where You Can Tighten Up for Added Revenue

Why This Topic Matters

Emergency department facility payment depends heavily on how service intensity is documented and translated into billing levels. Understanding the article’s scope helps readers judge whether they need guidance on observation composites, critical care documentation, pediatric acuity capture, and audit risk related to abrupt coding changes.

Article Sections

1. Introduction and reimbursement context

   Sets the stage for emergency department facility coding and billing issues in 2013, including the importance of accurate reporting and compliance. It frames the article around potential missed revenue and payment trends.

2. Assess These Areas For Missed Revenue

   Introduces several broad categories of emergency department services and circumstances that may influence facility acuity capture. The section focuses on areas where coding, nursing review, and service documentation can affect reimbursement.

3. Review Your Nursing Assessment Criteria

   Discusses the relationship between nursing assessment criteria, observation-related reimbursement, and facility level selection. It also references Medicare OPPS observation payment structure and composite payment considerations.

4. Pay Attention to These Peds Challenges

   Addresses pediatric emergency department services and why they can be difficult to capture using adult-oriented coding tools. The section emphasizes specialized resource use and documentation concerns for children.

5. Watch for Compliance Risks With Sudden Code Level Changes

   Covers audit and compliance concerns when higher acuity emergency department coding levels change unexpectedly. It focuses on documentation support, critical care recording, and internal review of templates and processes.