Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Emergency Department

Industry Orgs Fight Anthem’s Emergency Department Payment Policy

July 18, 2018 - The American College of Emergency Physicians (ACEP) and the Medical Association of Georgia (MAG) are suing Anthem’s Blue Cross Blue Shield (BCBS) of Georgia over a new policy that allows the payer to retroactively deny emergency department payment and coverage if the services are later deemed as non-emergent. In the past year, Anthem implemented the emergency services payment...

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NJ Passes Medicaid Reimbursement Cap on Non-Emergent ED Services

by Jacqueline LaPointe

Hospital emergency departments are one of the most expensive care settings, and New Jersey policymakers are trying to ensure providers only get paid for delivering emergency services to patients who truly need them. The Garden...

ER Spending Rose 99% Since 2009 Despite No Change in Utilization

by Jacqueline LaPointe

Emergency room (ER) spending per person grew 99 percent between 2009 and 2016 despite ER utilization remaining the same during the period, new data from the Health Care Cost Institute (HCCI) revealed. “Emergency room visits are not...

MedPAC Suggests Cutting Medicare Reimbursement for Stand-Alone EDs

by Jacqueline LaPointe

The Medicare Payment Advisory Commission (MedPAC) recently voted to reduce Medicare reimbursement by 30 percent for off-campus stand-alone emergency departments (ED) in urban areas. The recommendation will be included in the...

Care Coordination, Community Health Workers Reduce ED Costs, Use

by Jacqueline LaPointe

Average direct emergency department costs dropped 15 percent for frequent emergency department users after Brigham and Women’s hospital implemented a care coordination program using community health workers, according to a recent...

ED Spending Increases 85% As Hospitals Code for More Severe Cases

by Jacqueline LaPointe

Emergency department spending per member rose 85 percent between 2009 and 2015 primarily because of hospitals coding and billing for a greater number of high severity cases, new Health Care Cost Institute (HCCI) data revealed. Spending on...

Does Where Freestanding EDs Operate Change Hospital Payer Mix?

by Jacqueline LaPointe

Freestanding emergency departments (EDs) may be altering the payer mix at the equivalent hospital-based facility because the freestanding EDs tend to be located in areas with greater household incomes and insured rates, stated a recent...

Out-of-Pocket Healthcare Spending Rose 65% at Freestanding EDs

by Jacqueline LaPointe

Freestanding emergency departments are becoming a popular alternative care setting for common conditions, such as upper respiratory infections. But a recent study in the Annals of Emergency Medicine found that median prices for...

Unexpected Patient Financial Responsibility in 20% of ED Cases

by Jacqueline LaPointe

Approximately 20 percent of hospital admissions stemming from an emergency department visit in 2014 led to unexpected patient financial responsibility in the form of surprise medical bills, a recent Health Affairs study reported. Using...

How Emergency Providers Can Adopt Alternative Payment Models

by Jacqueline LaPointe

With many value-based care initiatives aiming to reduce costly emergency room visits, some emergency departments are finding it increasingly difficult to engage with alternative payment models, according to a report in the American Journal...

Despite ACA, Emergency Department Visits Remain Numerous

by Catherine Sampson

Although policymakers want to see the Affordable Care Act (ACA) lead to a reduction in visits to emergency departments, new data from the Centers for Disease Control & Prevention (CDC) raise concerns about the mandate’s real...

3 Strategies to Innovatively Advance Emergency Care Delivery

by Jacqueline DiChiara

The simple concept of value is a missing piece of the emergency department (ED) care spectrum puzzle, according to key findings released within Press Ganey’s white paper survey of over 1 million patients. Through the execution of...

End of Medicaid Fee Bump Could Impact Emergency Departments

by Ryan Mcaskill

The end of the Medicaid fee bump could cause an increase in inappropriate and costly emergency department usage. Last month, this blog covered news that the “fee bump” for Medicaid reimbursement would end on December 31, 2014....


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