The role of Emergency Medicine is an essential and complex component of the Affordable Care Act and its focus on wellness and disease management. Yet Emergency Medicine revenue cycle management faces a future of mounting regulatory constraints, compliance issues, multi-faceted documentation…and changes in reimbursement models that impact medical coding and billing.
In June 2012, the MGMA-ACMPE released the results of a questionnaire that ranked members’ most pressing practice management challenges. No. 2 was: Preparing for reimbursement models that place a greater share of financial risk on the practice.
Within the next five years, many Emergency Medicine physicians will be adopting this shared-risk model for revenue reimbursement (vs. fee for service) with the emergence of population health management through Accountable Care Organizations (ACO) that coordinate care and meet performance standards of care for Medicare patients.
As a result of ACOs and its correlating population health management and shared risk models, Emergency Medicine revenue cycle management models need to change too. New reimbursement models are emerging along with new models for emergency care.
With the emergence of off-campus urgent and emergency care centers across the country, there’s growing confusion overtaking many coders about which E/M code set to use in billing E/M services provided in these settings If it isn’t complicated enough, coders for freestanding EDs need to be aware of the rules governing whether or not a facility code can be charged for the visit in addition to a professional charge. Medicare has specific requirements for how a freestanding “emergency center” can be designated as a true emergency department and urgent care centers are defined in a completely separate category with different medical billing and coding requirements.
Rarely has there been a time more important than now for the unique nature of Emergency’s Medicine’s medical coding and billing to be managed with special expertise. It’s an exacting science that requires in-depth, insider industry expertise of the myriad of new Emergency Medicine revenue cycle management regulations that only an independent third party Emergency Medicine medical coding, billing and compliance specialist with decades of expertise can provide to ensure nothing falls through the cracks and revenues are optimized.
revMD.com is the results-proven alternative for healthcare revenue cycle management, with a niche specialization in medical coding and billing that generates unprecedented results and builds profitable medical practices. Leveraging a history of industry wide success spanning 25 years, revMD.com partners with medical practices in Arizona and throughout the U.S. to optimize revenue for hospital based and practice based physicians.