According to the Emergency Medical Treatment and Labor Act (EMTALA), ER providers are expected to provide emergency services to patients irrespective of their insurance status. Therefore, ER physicians face unique billing and coding challenges from the insurance and reimbursement perspective. This can affect the overall cashflow.

Physicians working in the ER experience a lot of pressure as they handle high patient volumes with varied diagnoses. The ER visits are unscheduled, and physicians need to act quickly, so most patients are admitted without proper insurance documentation. There is absolutely no time for physicians to explain to patients what their financial responsibilities are before providing treatment. Getting payments from these one-time patients can be hard.

Many ER physicians face challenges in collecting from insurance companies and patients because:

• They do not have the staff and office set-up that other specialty physicians have.
• Every patient is a new patient; therefore, the lack of follow-up visits makes it difficult to discuss a patient’s insurance and financial responsibilities.They do not prioritize claim submission, leading to money lost on auto trauma patients.
• They are unable to identify mistakenly denied claims.
• They experience delays in following up on self-pays and private-pay claims.
• They have limited working and follow-up of denials.
• They are unable to keep up with changes in an insurer’s payment process.

We improve reimbursement for ER physicians by:

• Negotiating contracts with insurance companies: We compare payor reimbursements, including renewals, to ensure that these are still appropriate for your present work environment.
• Providing flawless coding: Our expert coders follow guidelines to ensure that every claim is coded correctly.
• Prioritizing claim submission: We analyze the priority of each claim submission. Auto accident claims get utmost priority to attain 100% collection from auto insurance.
• Regularly analyzing account receivables : Our tight and regular A/R denial analysis maintains <1% A/R denial by making sure that:
  1. We submit clean claims
  2. There are no mistakenly denied claims
  3. There is no delay in following up with private-pay insurance
  4. We appeal and resubmit disputed claims until a satisfactory decision is rendered
• Promptly and rigorously following up on self-pay patients: The first statement is sent as soon as the information is recorded. Our policy of soft but rigorous collection includes:
  1. Offering several payment plans until the account is paid in full
  2. Offering payment via credit card
  3. Sending the account to a collection agency upon your approval if the patient does not respond after three statements and phone calls