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Pre-Billing Processes at the Emergency Department
Unlike the office environment, the emergency physician has little control of pre-billing
processes performed in the ED. Detailed review of pre-billing processes requires evaluation of:
- Emergency Department registration process
- Hospital information systems
- Time-of-service payment mechanisms
- Authorization process
- Missing record retrieval
- Transcription turnaround time
BSA Healthcare will perform a thorough evaluation of the pre-billing process
and provide quantification of potential revenue enhancement. Summary reports will suggest
reasonable solutions to problems identified, taking sensitivity of the hospital into account.
Frequently Asked Questions
Why does the facility E.D. bill get paid and not the emergency physician's bill?
Hospitals generally use information stored in the Hospital Information System (HIS) to generate
a bill. Typically, this information is much more accurate than the information sent to the
emergency physician's (EP) billing agent, who usually relies on information entered in the E.D.
Registration System. The demographic information on the HIS has frequently been updated and
corrected by the hospital's business office. These updates are generally authorization numbers,
addresses, and insurance coverage information. Unfortunately, many billing agents do not have
the technical ability or permission to access the hospital HIS System.
Why is the E.D. census so much higher than the number of claims sent out by the billing agent?
Many patients registered in the E.D. will not have EP claims generated for valid reasons. Elopements
(when patient walks out before information is received), private patients seen by their own physicians,
voids, and LWBSs (Left Without Being Seen) are some of the more common reasons. More troubling are
patients who have been seen by the EP, but an invoice is never created for this visit. Except for
purposeful no-charges, the common reason is a lack of document control and encounter tracking. Strict
controls must be implemented at every step in the billing process to ensure that all billable charts
are submitted to the billing agent with full documentation. Additional controls need to be present at
the billing agent to ensure that all billable records lead to a claim or statement generation.
What is the ideal turnaround time for transcribed records?
Ideally, the transcribed record should be in the E.D. within 24 hours, or transmitted electronically to
the billing agent within 48 hours. It is impossible to submit a claim without the provider documentation.
EPs should be intolerant of delayed transcriptions, both for billing and medico-legal reasons.
BSA Healthcare Services
EMERGENCY MEDICINE & PHYSICIAN SPECIALTY SERVICES
| HOSPITAL SERVICES
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