Defending emergency department reimbursement amid increased payer scrutiny

When it comes to determining emergency department (ED) facility visit levels, providers and payers have different perspectives on ED care and supporting resources. This difference in perspective creates friction. As a result, payers push back on ED facility visit levels and issue downgrades, denials and delays in payment.

In order to counter payer pushback on ED facility visit levels, hospitals must follow precise protocols for maintaining claims accuracy and consistency. In this paper, we present three key elements that hospitals can use to support defensible ED visit-level determinations and a three-step process for diagnosing areas for improvement.

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