Doc to Doc Series: What’s in your pocket at the end of an ED shift?

The New Rules of Engagement for ED Reimbursement

By Mark Laperouse, MD
Strategic Advisor to Ventra Health in Emergency Medicine.

With Medicare rates now effectively 26% less than they were two decades ago, we’ve reached a point where it is challenging to outrun low reimbursement by treating more patients – especially since the practice of medicine has evolved and now places increased demands on the provider for each patient encounter.

At the same time, Emergency Medicine is the specialty experiencing the highest level of burnout, according to the latest Medscape survey. Emergency physicians nationally see a median number of 2.1 patients per hour, and those patients are becoming increasingly more acute.  

It’s time for us to start working smarter, not harder, as the saying goes. This will require us to reframe our relationship to clinical documentation. 

No more box-checking

Under the “see more patients” strategy, paperwork is the enemy, inundating us with ancillary tasks that distract from patient care.

There’s another option. We can choose to be more effective and efficient with our clinical documentation, maximizing reimbursement for each patient we see.

In January 2023, the American Medical Association rolled out new Evaluation and Management (E/M) guidelines intended to reduce box-checking and to focus instead on clinical judgment and decision-making. In particular, we’re no longer required to document extensive patient histories and exams that are not relevant to the presenting case. The new guidelines eliminate “bullet counting” of the elements that used to be required to achieve reimbursement for higher level E/M codes. We now use our own judgment to collect “medically appropriate” histories and exams based on the problems presented at the visit.

What’s more, the new guidelines now factor in our processes and expertise. We can now be appropriately compensated when we document things like diagnoses considered but ruled out, time spent consulting with specialists, and higher risk levels of the treatments themselves.

The problem? Too many of us are fighting the new system with an unwillingness to adapt. We’re wasting time documenting services that aren’t considered as part of reimbursement, and we’re not documenting many of the critical services that are considered. With this practice, we are essentially giving away our medical expertise for free and, consequently, causing ourselves to be paid less per patient. It’s time that we emergency physicians stop undervaluing our own services and critical thinking.

This impacts all emergency physicians, whether they are paid by RVU or receive flat-rate compensation. RVU-based physicians will see the impact of better documentation sooner and more directly. However, all physicians ultimately benefit when the group’s reimbursement improves.

Learn the rules

More than ever, effective billing is a partnership between the physicians and coders. A trusted RCM partner is our best coach, ensuring our clinical documentation supports coding to the appropriate RVU level.

We can expect an RCM partner to help our practices transition to the new guidelines, train new physicians, identify ways to improve documentation, and even assist practices with updating charting templates to make documentation easier.

 Knowing the documentation rules of engagement will allow us to excel under the new documentation guidelines. The efficiencies we achieve will support patient care, affording us more time to spend at the bedside (where we want to be) or to comfortably see a few more patients per shift.

Learn more about the 2023 AMA coding updates

Download the “’Decoding’ the New AMA E/M Coding Guidelines for Emergency Medicine” white paper.

Download White Paper

Introducing the Doc to Doc Blog Series

Ventra Health brings decades of experience both in revenue cycle management and within the clinical specialties of our clients. Dr. Mark Laperouse is pleased to bring you a thought leadership series which draws from his clinical experience as an Emergency Medicine physician and the billing and coding expertise within Ventra. Stay tuned for the next installment of the “Doc to Doc Blog!”

About the Author

Mark Laperouse, MD is Medical Director Emergency Services at Our Lady of the Lake Hospital in Baton Rouge, LA, and Chief Medical Officer – Emergency Medical Services at Professional Emergency Physicians of Baton Rouge. He is a Strategic Advisor to Ventra Health in Emergency Medicine.