--- title: How to Combat Increased Coding Denials—A Three-Step Program description: Strict emergency department (ED) requirements from health insurance agencies and the government have resulted in higher rates of coding denials image: https://www.boostyourar.com/hubfs/zoll-ar-boost-landing-img.jpg --- [Client Login](https://portal.payorlogic.com/Home) - [Blog](https://www.boostyourar.com/blog) [![Let's Talk](https://no-cache.hubspot.com/cta/default/152170/b29945c8-b417-43df-a362-f8ed1bdd71be.png)](https://cta-redirect.hubspot.com/cta/redirect/152170/b29945c8-b417-43df-a362-f8ed1bdd71be) [![ARboostwebsitelogo](https://www.boostyourar.com/hubfs/ARboostwebsitelogo.svg "ARboostwebsitelogo")](https://www.boostyourar.com) - [Blog](https://www.boostyourar.com/blog) [Client Login](https://portal.payorlogic.com/Home) [![Let's Talk](https://no-cache.hubspot.com/cta/default/152170/b29945c8-b417-43df-a362-f8ed1bdd71be.png)](https://cta-redirect.hubspot.com/cta/redirect/152170/b29945c8-b417-43df-a362-f8ed1bdd71be) ![ZOLL-Pulse-Blog-Logo-FINAL](https://www.boostyourar.com/hubfs/Blog_images/Blog%20Logo/ar-boost-logo-final-approved-v2-white.png) [Ted Williams](https://www.boostyourar.com/blog/author/ted-williams) | June 4, 2019 # How to Combat Increased Coding Denials—A Three-Step Program *(2 min read) Tyler Williams of AR Boost (formerly PayorLogic) sat down with HFMA to shed light on the key to navigating nonpayment in emergency services billing. Read the full article *[*here*](https://www.hfma.org/Content.aspx?id=61984)*.* In recent years, increasingly strict emergency department (ED) requirements from health insurance agencies and the government have resulted in higher rates of payer medical necessity audits and coding denials in emergency medicine. There are three main factors contributing to this issue that healthcare providers need to be aware of—payment cuts to emergency medicine from major payers, incorrect coding of emergency departments claims, and failure to report inappropriate nonpayment activity. This blog breaks down each factor and offers ways for emergency departments to effectively combat billing issues. ### Payment Cuts in Emergency Medicine This year, Humana, Anthem and Medicaid announced new emergency department policies limiting the conditions they will cover and reducing the amount they will pay out. For example, one patient received a $12,000 dollar medical bill after an ED visit for a suspected ruptured appendix was deemed a non-emergency by one of those policies. Many patients may be looking at deductible increases of up to 100 percent—making them the primary payers for their emergency medical expenses rather than their insurance. ### Correct and Comprehensive Coding of ED Claims Healthcare organizations should make sure coders’ knowledge is up to date to ensure all coding is correct before ED claims are submitted. This is especially true for ICD-10 and Evaluation and Management (E&M) code assignment. Proper use of [Modifier 25](http://www.medicaleconomics.com/medical-economics-blog/everything-doctors-need-know-about-modifier-25) is an excellent example of the type of knowledge coders must maintain. Many insurers are proposing a 25 to 50 percent decrease in E&M reimbursement if Modifier 25 is applied. Thus, it is critical for coders to know how and when to use this modifier. The key to avoiding coding denials in the ED is to provide accurate documentation and coding within ICD-10. Here are four best practices for ED coding and documentation: - Cite a high-quality diagnosis to justify medical decisions - Give a specific, detailed final impression—don’t leave any unspecified ICD-10 codes - Expand clinical documentation improvement programs into the ED - Hire certified coders and billers with experience in ED billing ### Reporting Bad Behavior Rapid response to denials and lower payments and adequate coder training at every level are essential to addressing payment issues. Emergency departments should challenge or appeal any unfair denials with [EDPMA](http://www.edpma.org/) and [ACEP.](https://www.acep.org/#sm.00000th1wruer6eyjtagi6f1nw4v9) Finally, emergency medical centers should take steps that have been shown to address and correct bad payer behavior. The best approach is through a concerted effort among providers, combined with the following proven efforts: - Monitor clinical documentation and coding compliance - Hire knowledgeable staff - Take proactive measures in denial prevention for your organization’s emergency services *To learn more about how AR Boost (formerly Payor Logic) can help your organization combat denials in the emergency department, take a look at our *[*solutions for emergency medicine*](https://www.zolldata.com/contact-request-for-arboost)* today.* ![AR-white-200-x-64](https://info.zolldata.com/hubfs/AR-white-200-x-64.png) ### Subscribe to Our Blog Subscribe to our blog to learn from industry experts on how you can boost your healthcare AR. [Subscribe Now ](https://www.boostyourar.com/subscribe-to-the-arboost-blog) #### More About the Author: ## [Ted Williams](https://www.boostyourar.com/blog/author/ted-williams) Ted Williams has been a featured presenter at regional and national EMS conferences, including the state medical associations, ambulance networks, and technology user group conferences. Williams is a founder of Payor Logic, a national provider of healthcare revenue cycle solutions. ## Related **Posts** [Ray de la Pena](https://www.boostyourar.com/blog/author/ray-de-la-pena) | Feb 06, 2020 #### [Medicare Beneficiary Identifiers Accelerate Claim Payment](https://www.boostyourar.com/blog/medicare-beneficiary-identifiers-accelerate-claim-payment) (4 min read) On January 1, 2020, the Centers for Medicare and Medicaid Services (CMS) made the formal shift to the use of [Read More ** ](https://www.boostyourar.com/blog/medicare-beneficiary-identifiers-accelerate-claim-payment) [Kelli Turner](https://www.boostyourar.com/blog/author/kelli-turner) | Dec 18, 2019 #### [Four Ways Billing Teams are Addressing the Rise of the Self-Pay Patient](https://www.boostyourar.com/blog/four-ways-billing-teams-are-addressing-the-rise-of-the-self-pay-patient) (5 min read) “Self-pay” used to be a designation reserved for patients who are uninsured and covering the cost of medical expenses on their own. Over recent years, this ... [Read More ** ](https://www.boostyourar.com/blog/four-ways-billing-teams-are-addressing-the-rise-of-the-self-pay-patient) [Jennifer Carlson](https://www.boostyourar.com/blog/author/jennifer-carlson) | Oct 30, 2019 #### [Improve Patient Financial Experience with the Right Tools](https://www.boostyourar.com/blog/improve-patient-financial-experience-with-the-right-tools-at-the-right-time) (5 min read) The domino effect of rising deductibles, increased patient financial responsibility and the ensuing impact on provider reimbursement has catapulted patient ... [Read More ** ](https://www.boostyourar.com/blog/improve-patient-financial-experience-with-the-right-tools-at-the-right-time) #### Stay in the know and subscribe to the AR Boost blog ##### You Might Also Like: ## [![ZOLL Data](https://www.boostyourar.com/hubfs/zoll-logo-main-white.svg "ZOLL Data")](https://www.boostyourar.com/) 11802 Ridge Parkway, Suite 400 Broomfield, Colorado 80021 U.S.A. 1.800.474.4489 [Contact Us](https://www.zolldata.com/contact-us) [Customer Community](https://www.zolldata.com/customer-community) [** ](https://twitter.com/zoll_rescuenet) [**](https://www.facebook.com/zoll.emsfire/) [**](https://www.linkedin.com/company/zolldata/) ### [Features](https://www.zolldata.com/arboost) ### [Resource Library](https://www.zolldata.com/resource-library) ### [About Us](https://www.zolldata.com/arboost) - [Events](https://www.zolldata.com/calendar-of-events) - [News](https://www.zolldata.com/media-coverage) - [Contact Us](https://www.zolldata.com/contact-us) ### [Blog](https://www.boostyourar.com/blog) © Copyright 2023 ZOLL Medical Corporation. 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