THE FUTURE OF EM CODING/BILLING

THE FUTURE OF EM CODING/BILLING

References:
https://ahsrcm.com/medical-billing-news/emergency-medicine-billing-news/keeping-the-emergency-department-healthy/
http://newsroom.acep.org/2015-05-04-ER-Visits-Continue-to-Rise-Since-Implementation-of-Affordable-Care-Act

SITUATION:

In the US, the ED continues to be the “safety net” providing care to those that cannot afford primary physician care, those that have emergency needs 24/7 and meet the disaster needs of communities suffering catastrophes.  Critics speculate that EM services will be wrapped/bundled into other hospital outpatient/inpatient services and EM will diminish as an independent service entity.

BACKGROUND:

For more than 3 decades the US has been unsuccessful at meeting the primary care needs of the population.  Passage of the ACA was intended to support better primary care access by creating a payment mechanism for heretofore uninsured citizens.  Since ACA passage, those states that expanded Medicaid programs have witnessed material growth in Medicaid enrollees – States that chose not to expand their Medicaid programs have witnessed increased volume in the EDs.  Actual increase in Primary Care physicians has not occurred.  This newly insured cohort is largely utilizing the ED at increased rates.  CMS has piloted bundled payment projects to connect ED care with inpatient episodes.  These projects have been inconclusive in substantiating that Alternative Payment Methods (APM) have changed ED usage nor have they substantiated that alternative payment methods change the hospital behavior.

SITUATION:

ED use has increased and assuming that the ACA will continue in some fashion, this trend seems likely to continue.  Hospitals have been largely unsuccessful in attempts to employ and manage EM groups.  Large outsourced physician vendors staff less than the majority of EDs in the US – there seems to be a viable business opportunity for independent EM physician groups, particularly those with multiple contracts and regional presence (this allows economies of scale and competitive recruitment and retention strategies).  These regional independent groups need, and demand, strong coding/billing partners.

RECOMMENDATION:

The business opportunity for specialty coding/billing companies with established industry expertise (EM, for instance) seems promising.