There are 300 kinds of services provided under Emergency Room (ER) services and a few of them are entitled to insurance reimbursement. Each procedure code has a distinct set of criteria and unless the care provider properly establishes with documentation that an emergency treatment episode meets all of them, it leads to claim rejection. Also in relation with emergency medicine, EMTALA which governs emergency services in the US mandates that emergency services be available to all regardless of ability to pay or insurance coverage.

This leaves care providers and hospitals to deal with not just an increased number of patients but also procedural complications like accurately identifying which services are eligible for reimbursement, documenting such treatment episodes accurately, and preparing and submitting claims.

Since these activities are not as simple as those in other disciplines, it takes trained abilities and understanding to meet all the requirements. For instance, determining whether emergency room services are covered by insurance calls for both medical expertise and familiarity with relevant laws.

Contracting out to PBC

The medical billers and coders at PBC possess the necessary level of expertise to manage the intricacies involved in ER billing. They can assist you with every step of the emergency medicine billing process, from precisely determining which cases are eligible for reimbursement and their procedure codes to recording their qualifying requirements and creating and submitting their claims.

Our billing professionals have years of experience in a variety of healthcare environments, which gives them an advantage over others. In addition to having a theoretical and practical understanding of EMTALA, its implications, and procedural requirements, they recognize that emergency room services are only one aspect of a larger treatment cycle, in which the actions taken—whether it be administering a treatment or documenting it—form the basis of the entire administrative and medical episode, especially in large hospitals that combine surgical and emergency services. This understanding aids in the efficient operation of our emergency medicine billers and coders, facilitating the subsequent phases of a treatment procedure in terms of paperwork and other procedural issues.

With PBC’s adaptable emergency billing and coding services, you may select the plan of care that best fits your needs and those of your company. With the aid of our revenue cycle management (RCM) services, you will:

• Tighten your revenue management procedure by substituting out-of-date software with suitable programs that meet your needs and facilitate the HIPAA-mandated electronic data transmission method.
• Simplifying your current workflow by eliminating pointless steps and procedures, finding areas where money is being lost, and determining what training is required