E/M level billed by Physician the same as Facility

The #1 Most Common Mistake occurs when your staff believes that the Evaluation and Management [E/M] level billed by the ED Physician must be the same level as that billed by the hospital for the ED Facility.

This is simply not true. The Physician E/M Level is based on the Physician’s documentation according to either the 1995 or the 1997 E/M guidelines, which includes the history, exam, and medical decision-making components.

By comparison, the Facility Level is based on documented resources and staff utilized by the department in conjunction with an appropriate point system. (We’ll discuss what an appropriate point system consists of in our next blog). Therefore, the Physician Level of service does not need to be the same as the Facility Level of service.

Two Separate, Yet Necessary, Services

Try thinking of it as two separate, yet necessary, services that occurred at the same event for the same client, but with two unrelated measurement systems being utilized in determining how to best account for what was expended by each in the process. The notion that somehow the two must be billed at the same level is clearly a misnomer, yet is thought to be true by many more practitioners today than one would imagine. The end result leads to the loss of legitimate, appropriate revenue capture for no other reason than to maintain the same billing level between each, regardless of actual services performed.