PAYMENT ACCURACY

Emergency Room Compliance Review

Part of our suite of Payment Integrity solutions.

Level 5 emergency room billings are way up. It’s time for a closer look.

Billing of the most serious and costly emergency room visits increased over 215% between 2012 and 2019.

American Medical Association CPT Guidelines characterize the clinical conditions appropriate for level 5 ER visits as those that “are of high severity and pose an immediate threat to life or physiologic function.” So, you might expect that an increase of 215% would cause a similar rise in hospital admissions. In fact, admissions went down during this period. Time for a closer look.

Our purpose-built solution thoroughly validates your level 5 ER billings, so you can rest in the knowledge that you are paying only for legitimate claims. Our system requires only claim data, meaning reviews are conducted without the need to wait for medical records from providers.

We’d love to chat about how our solution can help your plan.