By Jamie Shoemaker, MD, FACEP
Hospital-employed emergency physicians are navigating complex financial pressures while they strive to deliver high-quality patient care. One area ripe for improvement is the management of billing and coding practices. Many hospitals rely on their in-house billing and coding teams to handle emergency department (ED) claims, but this can lead to missed revenue opportunities due to under-coded charts. By outsourcing billing and coding to specialized firms such as Ventra Health, hospitals can significantly boost reimbursement, enhance their bottom line, and reinvest in key areas such as physician salaries, benefits, and patient experience.
The Problem with In-House Billing and Coding
The American healthcare system is notorious for its labyrinthine coding requirements, and as these guidelines shift, staying compliant requires specialized attention and continuous training. Hospital-employed coders often lag in this regard, particularly as emergency departments experience high patient volumes and a diverse range of cases. They may also be managing charges for a wide range of specialties and lack the specific expertise required to handle the complexities of emergency medicine.
These challenges lead to under-coded charts, where certain procedures, evaluations, or treatments aren’t fully captured, resulting in lost revenue for both the physician and the hospital. The likelihood of coding errors or missed revenue opportunities is highest for more complex or higher-paying services that demand precise documentation.
The Benefits of Outsourcing Billing and Coding
By outsourcing billing and coding to an RCM expert like Ventra Health, hospitals can partner with a specialized firm that employs experts trained specifically in emergency department coding. These teams are highly skilled in the latest coding guidelines and reimbursement rules, ensuring that charts are coded accurately and completely. The benefits of outsourcing include:
- Maximized Reimbursement: Outsourcing firms specialize in identifying missed revenue opportunities. Their attention to detail ensures that all eligible procedures, services, and care provided are captured, leading to increased billing accuracy and higher reimbursements for both physicians and hospitals.
- Audit-Driven Improvements: Third-party billing and coding firms such as Ventra Health often conduct regular audits, identifying discrepancies and helping hospitals adjust their documentation processes to better align with coding standards. These audits not only maximize revenue but also mitigate the risk of non-compliance with federal regulations, reducing the potential for costly penalties or investigations.
- Boosting Hospital Revenue in an Era of Thinning Margins: Healthcare providers are operating in an environment of shrinking margins, making every revenue stream more critical. Under-coded charts represent lost income, which could be reclaimed through specialized outsourced services. The additional revenue generated through correct coding and optimal reimbursement has a direct impact on the hospital’s financial health.
- Reinvestment into Salaries, Benefits, and Patient Experience: Increased revenue from outsourcing billing and coding doesn’t just benefit the hospital’s bottom line—it also allows for reinvestment into improving physician compensation, offering competitive salaries and benefits, and enhancing patient experience initiatives. When hospitals operate more efficiently, they create a stronger workforce and better outcomes for patients, which is critical for long-term sustainability.
Staying Ahead of Changing Billing Guidelines
The billing and coding landscape is continuously evolving, driven by regulatory changes, updates to Medicare and Medicaid, and shifting reimbursement models. For Emergency physicians, who are often at the front lines of patient care, ensuring that their services are billed correctly is crucial. Unfortunately, hospital-employed coders may struggle to keep up with these rapid changes. This disconnect leads to underbilling, leaving valuable revenue on the table. Outsourcing to experts who specialize in emergency medicine coding ensures compliance and revenue optimization in this fast-paced environment.
Conclusion: A Win-Win for Physicians and Hospitals
Outsourcing billing and coding presents a strategic opportunity for hospitals and their employed Emergency physicians to optimize financial performance. By working with specialized coding firms, hospitals can increase revenue through correct and comprehensive coding, allowing them to capture previously missed income. This increased revenue can be channeled back into the hospital, improving physician salaries, enhancing benefits, and delivering a superior patient experience. In an era where healthcare providers are under immense financial strain, outsourcing billing and coding is not just a smart move—it’s a necessary one.
Contact Ventra Health to Learn More
About Jamie Shoemaker
Jamie Shoemaker, MD, FACEP, is an Emergency Medicine Strategic Advisor with Ventra Health. A distinguished Emergency Medicine physician, Dr. Shoemaker has more than 25 years of clinical experience. He is also a leader in the ACEP community and a well-known government advisor who has spent decades shaping physician reimbursement policy and legislation at both the Federal and state levels. He currently serves as Director of Quality at Elite Emergency Physicians, Inc. in Elkhart, Indiana, and will continue to practice medicine alongside his new role at Ventra.
