Billing: Are You Overlooking These Areas Where Your ED Could Be Bringing in More Money?

Why This Topic Matters

Emergency department groups can lose revenue from documentation gaps, claim errors, denials, slow payer response, and missed patient collection opportunities. The article highlights broad billing workflow areas that may help staff identify where revenue is being left on the table.

Article Sections

1. Diagnosis Sequencing

   Discusses the importance of ordering diagnoses correctly in emergency department claims and the revenue cycle impact of incomplete or misplaced documentation.

2. Avoid Unspecified Diagnoses

   Covers the general issue of avoiding vague diagnosis reporting when more complete documentation is available.

3. Confirm That All E/M Elements Are Present

   Reviews documentation completeness as it relates to emergency department evaluation and management claim levels and possible downcoding concerns.

4. Stay on Top of Shifting Insurer Regulations

   Summarizes the need to monitor payer policy changes and claim processing requirements across different insurance types.

5. Verify Patient Coverage

   Addresses insurance coverage verification and the timing of patient eligibility checks during the visit workflow.

6. Scrub Your Claims

   Explains the role of claim scrubbing, clearinghouse review, and error detection before claims are submitted.

7. Work Your Appeals

   Focuses on denial follow-up and the general use of appeals with supporting documentation.

8. Run Aging Reports Frequently

   Discusses claim follow-up monitoring and aging report workflows after submission.

9. Check Self-Pay Patients for Medicaid Eligibility

   Covers screening self-pay accounts for possible Medicaid eligibility and related billing follow-up considerations.

10. Offer Additional Payment Options

    Describes patient payment collection options and tools that can support easier bill payment.