Hospitals are providing quality care for their patients, but are challenged with receiving adequate reimbursement from payers, particularly with emergency room services. Some payers have adopted zero-pay or reduced payment for non-emergent use of the emergency department (ED). The burden is on the provider to add more resources and staff to manage this policy or the bad debt. As such, the following suggestions should be reviewed and considered.
- If a hospital does not have the bandwidth to manage this policy, utilize an outsourcing vendor that is on a contingency basis. This vendor should have a proven, successful track record in overturning denials and/or underpayments.
- Negotiate contract terms that are favorable to the provider on emergency room reimbursement policies.
- Utilize a contract management solution that immediately identifies underpays, denials, and variances by services line items. With this data, a hospital can run predictive analytics.
- Have a coding team that understands each payer reimbursement nuance and be able to code the correct level of care. This is paramount in getting better reimbursement as many providers will down-code to avoid denials or underpayments.
As more payers get on the band wagon of reducing or denying ED visit claims, providers have to be diligent in their approach. Parathon has the software and services that can address ED zero-payment policies.
