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Tyler Williams | April 2, 2019

How to Overcome Hurdles in Emergency Room Billing

Managing Self-Pay Revenue

(3 min read) I contributed an article on managing self-pay revenue in emergency medicine to HBMA’s May – June 2018 issue. The following blog post covers some of the key points from my article.


Emergency medicine lies it’s focus squarely on one objective – saving lives. This singular focus is crucial to emergency departments, but means secondary details, such as upfront insurance verification, often get overlooked. Unfortunately, emergency medicine needs upfront verification just as much, if not more, than other departments. However, gathering correct demographic and insurance information isn’t so easy with critical patients.

The various laws and regulations surrounding emergency medicine add additional levels of difficulty to this equation, especially when dealing with self-pay patients. Considering that self-pay makes up an estimated 10% of the average emergency department payor mix, it’s easy to see the financial risk emergency practices bear.

The following are three methods practices and their billing staff can use to circumvent the hurdles associated with emergency room billing.

Verify Demographics Upfront

Accurately gathering a patient’s demographic information upfront ensures the correct bill is sent to the correct payor, which is essential in self-pay situations. However, self-pay revenue isn’t the only place where demographics verification is important; inaccurate demographic information is one of the most prominent reasons for denied claims and failed insurance eligibility. By gathering demographic information on the front-end, the billing process becomes much more precise, regardless of the payor.

To achieve this task, emergency billing staff should make use of all the resources available to them. Consumer databases can greatly aid in upfront verification by allowing patients’ demographic attributes to be quickly searched and confirmed. By verifying patient demographics upfront, billing staff can:

  • Reduce returned mail and billing costs
  • Experience fewer claims rejections and payment delays
  • Minimize costs and risks associated with inaccurate demographics

Find Insurance Coverage in Real-Time

AR Boost (formerly Payor Logic) has found that up to 35 percent of emergency practice patients per week have no insurance on file. Traditionally, this scenario creates a cog in the workflow for an emergency practice’s billing team. Patient information is sent to a clearinghouse or insurance service, and no action can be taken until feedback is provided. Once the third party does respond, this information must be re-entered into the provider’s billing system.

Real-time technology greatly expedites this process. New platforms allow the integration of an emergency provider’s billing system and insurance discovery service. The result is immediate access to all online search capabilities, and the elimination of all wait times.

Determine Patient’s Propensity to Pay

If emergency billing staff can determine a patient’s ability to pay early on, they can segment accounts and assign their focus accordingly. Once patients are filtered based on their propensity to pay, those who are most likely to pay or eligible for a payment plan are placed at top priority for billing staff. Conversely, patients who are unlikely to afford their bill should be quickly written off or moved to charity care or Medicaid. This practice leaves the billing staff with fewer accounts to manage and lessens the amount of accounts sent to a collection agency, effectively streamlining their work.

Given the specific challenges inherent in emergency medicine reimbursement, now is the time for practices and billing companies to institute new processes and technologies to recover the money owed to them. Read the full HBMA article here.


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Tyler Williams