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Emergency Billing & Coding Services

An emergency department, also known as an emergency room, is a medical treatment facility specializing in emergency medicine. Emergency medicine is the acute care of patients who present without a prior appointment, either by themselves or by an ambulance. One can find an emergency department in a hospital or primary care centers.

Due to the patient flow's unplanned nature, the ED department must provide initial treatment for a broad spectrum of illnesses and injuries, some of which may be life-threatening and require immediate attention.

Emergency Billing Services

Typical Issues in getting reimbursed for ED Services

Emergency medicine billing Services are highly unique compared to other forms of medical billing. The complexity is due to the unpredictable nature of patient intake. It relies heavily on the patient care report prepared when the ambulance picks up the patient from where the need arises

Typical issues with ED billing are :

Missed Charges or high incidence of DNFB(Discharges not fully billed) : Due to emergency departments' fast-paced nature, further compounded by a lack of understanding of clinical documentation responsibilities.

Finding great ED coders : ED coders have dual responsibility for accurate coding and identifying DNFB cases. They need to work with physicians to reduce DNFB, and possess the ability to understand trends and patterns in clinical documentation and charges is essential.

Credentialing issues : Often, Emergency Departments require specialist physicians. Ensuring the credentialing of most of the regular specialists with common payers in the region will improve the reimbursements you receive.

Life Support Systems : A slight error in the specific terminologies for the service provided, such as service provided for Basic Life Support (BLS), Mileage documentation, Advanced Life Support (ALS), leads to denials Misuse of the modifiers used to code for place of origin and destination of the ambulance trip can delay the claim processing time.

Medical Necessity : The coders must understand the criteria that determine "medical necessity" to code for the various levels of ground and air ambulance Services used. It is essential to stay updated with the rules of emergency room billing as it changes frequently Many insurance plans pay unexpected benefits as per a plan and majorly do entertain contracting ER doctors.

Medical Billing & Coding Services Expertise in ED Billing & Coding

At RM Healthcare, we have a client base that spans across all 50 states, covers a wide range of hospitals, physician practices, and medical billing companies. We employ our experience and knowledge acquired through a decade of working with ED doctors in fixing & improving your revenue cycle. Our coders are proficient in ICD-9/10, CPT, HCPCS coding guidelines provided by CMS and AMA, and are certified by the American Academy of Professional Coders (AAPC).

Applying best practices for ED Billing & Coding Services

At RM Healthcare, we recognize ED billing & coding challenges, such as high out-of-pocket expenses and the prudent layperson rule. We work with your group to solve them as a business partner.

Our certified coders work with you 24/7 to prevent problems caused by incorrect use of modifiers, as well as educate your in-house billing specialist on how to avoid them. We also look for discharges not fully billed to identify unbilled procedures and improve reimbursements. Our Services cost is often covered many folds by the additional reimbursements for Services that Emergency Departments leave on the table. We do this by focusing on efficient, streamlined processes that decrease the amount of time needed to bill emergency department Services correctly.

We have built our approach using modern technology, and the team focuses on providing data-driven solutions that help reduce denials and increase revenue.

Benefits of our ED Billing and Coding Services :

We bring excellence, knowledge, and accuracy to ED billing and coding Services while building a revenue cycle devoid of defects for your practice. With patient demographics entry, insurance verification, insurance authorizations, coding, billing, and reconciling of accounts, our medical billing process can add value to your organization. Our team strives to introduce a friction-free billing, coding, claim submission, and payment posting process. We ensure consistent accounts receivable follow-up and prior authorization to avoid claim denials. Our denial management team's #1 priority is shifting your focus from denial management to denial prevention. We bring you a group of specialists who are:

  • Certification from The American Association of Professional Coders (AAPC)
  • Familiar with medical billing software such as Lytec, Medic, Misys, Medisoft, NextGen, and many more
  • Coders trained in coding software such as EncoderPro, FLashcode, CodeLink, etc.
  • Being able to apply standard CPT, HCPCS procedure and supply codes, and ICD-CM diagnosis coding as per CMS guidelines
  • Successful track-record of processing medical bills with leading commercial carriers such as United health, WellPoint, Aetna, Humana, HCSC, Blue Cross Group, etc.,
  • Ability to negotiate successfully with Medicare and state-specific Medicaid policies
  • Ability to identify DNFB cases and educated physicians on unbilled procedures as well as improve clinical documentation

Our clients typically see an improvement in revenue by 30% and a reduction in denials by a minimum of 10%. We achieve this by applying our expertise, process rigor, latest technology and by employing an excellently trained team.


RM Healthcare handles more than 250,000 patient support calls each month