Document Type: E-Book

While providing high-quality patient care is the number one priority for all healthcare organizations, maintaining fiscal stability is another top concern. Not only does an effective revenue cycle management strategy keep the doors open of your healthcare facility and  goes hand in hand with patient satisfaction.

The need for an efficient revenue cycle management process was especially highlighted after the financial challenges of COVID-19. While the significant revenue and volume losses, and dwindling margins due to canceled elective procedures, shortage of ICU resources, and furloughs resulted in the closure of many healthcare practices ???, it also illustrated the importance of an optimized revenue management process everywhere else.

A healthcare revenue cycle process is a multi-faceted activity that is no longer just billing, coding, and collection. With many steps like pre-registration, registration, charge capture, utilization review, coding, claim submission, 3^rd party follow-up, patient responsibility, remittance processing, and denial prevention, there is room for error at every step of the cycle. If a claim misses a pre-authorization or any other data, payment may be delayed due to claim denial and unbilled revenue for services rendered is the primary cause of hospital debt.

An exceptional revenue cycle process is a key to transforming that debt into recurring profit. The traditional approach of extensive interactions between payers, hospital staff, and insurance providers to manually extract data is time-consuming, and ineffective in this value-based care landscape, not to mention highly prone to costly errors. This is why you need to stop relying on historical methods and rethink your healthcare revenue strategies and develop innovative and efficient ones.

To improve the performance, productivity, and efficiency of your revenue cycle, the following strategies have proven to be effective in leading healthcare practices across the world.

1. Automation of Workflow

A healthcare practice contains thousands of financial reports entering and leaving the system each day, each requiring thorough data analysis. However, doing this manually with outdated legacy software is not only time-consuming, but also increase the chances of human errors as it likely  for a human to miss something or misinterpret it. Highly repetitive tasks like eligibility verification, follow-up of claim status, creation of patient status, and determining which of the thousands of claims on standby deserve prompt attention can be easily automated to streamline workflow. Read More.

According to the CDC, around 130 million people visit the emergency department (ED) in the US each year. An ED is at a critical intersection of inpatient and outpatient services, often the point of contact between patients and the hospital or primary care center. Since people can walk in anytime, via an ambulance or on foot, without a prior appointment, it sees an extremely high patient turnover which makes an ED extremely busy. Additionally, the emergency rooms (ER) of today are not the same as those two decades ago. Rather than receiving limited workups and then being admitted as inpatients for further evaluation, the ERs now handle evaluation, investigation, examination, diagnostic tests, and treatment of a broad spectrum of injuries and illnesses. They specialize in everything from primary care and minor surgical procedures to observation care and trauma services, as well as advanced critical care if need be.  Some hospitals specializes in offering trauma services. This added responsibility, in addition to the unplanned, fast-paced, and high-volume nature of an emergency room (ER), presents unique challenges that are not found in any other specialty. Besides delivering high-quality care, an ED must also maintain appropriate clinical documentation and perform meticulous emergency department coding to receive timely reimbursements from insurance providers. The rapidity and volume of this specialty make emergency room billing guidelines a bit more complicated, requiring careful understanding and ample experience. This guide breaks down the basics of emergency department coding. After starting with the need for proper coding, we will delve into the specific forms used, CPT codes, modifiers, exceptions, critical care, and the key considerations to ensure effective billing.

Why is Emergency Department Coding Challenging?

The unpredictable nature of an ER makes emergency department coding complex, relying heavily on patient reports generated at each stage of care. The challenges affecting claim reimbursement in an emergency department can be summarized as follows.

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