10 Common Mistakes Managing Emergency Department Reimbursement and Cash Flow

Believing 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.

The 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.

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Failing to evaluate and adjust your Point System on a systematic basis.

The 2^nd most common mistake is that the Facility Point System is not regularly evaluated to capture all services. A Point System would be a consistent methodology for assigning an ED Facility Level based on the work performed by the ED staff. An interesting fact is, that to this date, there are no national standards for assignment of hospital Facility Levels.

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Failing to consistently educate all members of your ED staff regarding your Point System

A 3^rd common mistake is the inconsistent interpretation of the point system by the staff. Once the Point System is developed, it is imperative for all staff members to accurately and consistently interpret not only how the point system is being used, but also how it was intended to be used.

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Overlooking to regularly review and update all of your documentation templates

The 4^th common mistake occurs when your documentation templates are no longer capturing all services appropriately.

Failing to document the length of time used for your time based services

Are you capturing your time based procedure / service codes?

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Choosing and then utilizing the wrong Evaluation and management guidelines for your ED

The 6^th common mistake for revenue capture is relying solely on your EMR to capture the appropriate E/M Level.

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Not automatically updating your Fee Ticket/Superbill annually

The 7^th common mistake occurs as a result of your Fee Tickets / Superbills not being updated on a regular basis.

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Not conducting chart reviews on a regular and consistent basis

The 8^th common mistake in managing cash flow is due to the lack of chart reviews / audits.

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Failing to show your providers [E/M] Bell Curves that compare their coding to that of their peers on a National Benchmark

The 9^th common mistake that can impact reimbursement can occur when your provider does not know where he/she falls on a National E/M Benchmark Bell Curve.

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Experiencing the same mistakes over and over as a direct result of not providing ongoing training and coaching for your providers and staff

The 10^th common mistake that will often affect revenue is an ongoing lack of education for all of your Providers and Staff. They should each receive focused instruction as a direct result of ongoing and consistent chart reviews.