Er Trauma And Critical Care

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

ER Trauma and Critical Care Physician Billing

Emergency medicine is unlike any other specialty. ER physicians operate under relentless pressure, high patient volumes, unpredictable case complexity, 24/7 coverage, and strict billing regulations. Every second counts in the ER, and physicians must devote their full attention to saving lives. Behind the scenes, billing teams play an equally critical role: ensuring claims are submitted quickly, accurately, and compliantly.
Our ER Physician Billing Services are designed to meet the unique demands of emergency medicine. We handle the complexity of billing and collections so physicians can focus on patient care. With proven systems, specialized expertise, and patient-friendly processes, we maximize reimbursement while reducing administrative burden.

Our RCM Approach

We handle the entire billing and credentialing process with precision and efficiency:

1. Credentialing & Enrollment
• Fast enrollment with commercial and government payers.
• Active network status secured to avoid delays in patient coverage.
• Ongoing support for recredentialing and payer updates.

2. Our Billing Process
• Prioritization of Claims
We treat every claim with urgency, but auto accident cases receive special attention due to their complexity and strict filing timelines. By prioritizing these claims, we protect providers from missed deadlines and ensure compliance with state and federal requirements.
• Verification of Accident Information
Accident details are carefully verified with insurance carriers. Once the billing log is received, claims are filed immediately to avoid delays. This proactive approach ensures timely filing and prevents costly denials due to PIP exhaustion.

3. Claim Submission & Tracking
• Clean claim submission with payer-specific compliance checks.
• Real-time tracking to reduce denials and speed up payments.
• Automated systems to monitor claim progress.

4. Payment Posting & Reconciliation
Whether payments arrive electronically or by paper check, they are posted and reconciled promptly. This ensures:
• Accurate posting of insurance and patient payments.
• Identification of underpayments or discrepancies for quick resolution.
• Streamlined reconciliation to maintain clean financial records.

5. Denial Management
Denied claims are not the end of the story. Our team follows up directly with payers to resolve issues quickly, preventing missed deadlines and protecting provider revenue. With strong appeal strategies and compliance expertise, we minimize revenue leakage.
• Proactive follow-up on denied or underpaid claims.
• Strong documentation support to strengthen appeals.
• Recovery strategies to minimize lost revenue.

6. Patient Billing & Collections
For patients without insurance – or those who owe balances after insurance has paid—we provide clear, compassionate billing. If accounts remain unpaid, they are sent to collections, but we balance rigorous recovery with patient support. Clear communication with patients and families about balances.
• Transparent billing practices that improve satisfaction and trust.
• Efficient collection processes to ensure timely payments.
• Flexible payment options include:
o Check
o Credit card
o Structured payment plans

7. Financial Reporting
• Detailed monthly and quarterly reports on collections, denials, and payer trends.
• Actionable insights to improve cash flow and operational efficiency.
• Customized dashboards to track performance and support strategic decisions.

Why Choose Us?

• Proven Expertise – Decades of success with auto, government, and commercial insurance billing.
• Strong Collection Rates
o 99% collection success from auto insurance payers
o 100% collection success from government programs and commercial insurance carriers
• Transparent Processes – Clear reporting and compliance safeguards that protect revenue.
• Patient-Friendly Collections – Strategies that maintain trust, compassion, and regulatory compliance.

Er Trauma And Critical Care