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 Reimbursement Sub-Topics


ICD-10-CM And The Emergency Physician Information Paper  

The October 1, 2015 implementation date for switching from ICD-9 to ICD-10 is fast approaching. You should be preparing now so your claims processing and revenue stream are not negatively impacted. The ACEP Coding and Nomenclature Advisory Committee (CNAC) has prepared an information paper to help explain the changes to make the transition easier.


ICD-10-CM For The Busy Emergency Physician   

This ICD-10-CM manual was created by ED physicians for ED physicians to help provide an easy to read, clinically based reference.


ICD-10-CM ED Clinical Examples      

The list of definitions for precise documentation of specific anatomical injury or illness. 


The American College of Emergency Physicians (ACEP) has collaborated with the Physicians Advocacy Institute (PAI) to develop a Toolkit for Physicians Facing Medical Audits.  The Toolkit provides practical information and tips to guide physicians in anticipating medical audits, responding to auditors’ requests for medical records, and appealing erroneous audit findings. The Toolkit also includes detailed information regarding the various types of governmental and private payer audits, appellate procedures, and extrapolation methodologies used by some payers to calculate alleged overpayments.  The toolkit can be accessed at the following link:   


Preparing for Payer Audits   

The American College of Emergency Physicians developed this document to provide its members basic guidance on preparing for payer audits. Due to differences in regional/state/and jurisdictional precepts, rules and regulations, legal guidance should be sought from a qualified attorney in the relevant locality as early in the payer audit process as possible.  

Why Higher Acuity of Emergency Medicine E/M Codes  

Why Higher Acuity of Emergency Medicine E/M Codes Condensed - Over the past few years, the Centers for Medicare & Medicaid Services (CMS) has observed a shift of Evaluation and Management (E&M) codes in the Emergency Department (ED), prompting their concern for excessive payments by CMS to emergency physicians. The purpose of these papers is to inform practicing emergency physicians why this code shift has occurred. Unless otherwise noted, he points that follow are pertinent to Medicare. 

Emergency Medicine and Payment Reform - Healthcare reform is introducing evolving methodologies for payment as opposed to the traditional fee for service model. Not all of the new payment methodologies work well in the ED setting. This paper from the ACEP Reimbursement Committee outlines the various options being discussed and the potential impact on the ED. 

Top 20 ED Codes 
This chart lists the 20 most often services provided in the ED along with their 2014 Medicare RVU allocations. 

 Reimbursement and Coding Update for 2014  

 Several factors will impact emergency physician reimbursement for 2014, and many important coding updates have been made that impact emergency department procedures. 

Remember to Use the Fair Health Discount Code 
ACEP has arranged for its members to receive a 20% discount on the FH Fee Estimator, a new source of independent charge data from private insurance claims.

Medicare 2013 E/M Frequency Distributions  -2013 Medicare frequency distribution data for Emergency Physicians. (This is the most recent data available)  

FAQ on Reimbursement and Coding Updated  -Revisions to the CPT and ICD 9 codes always spark a few questions. ACEP has updated its FAQs in reimbursement reflect changes for 2014.   Visit the FAQs section to view the updated lists   

Reimbursement Pearls 
These are short tips, typically between 50 and 150 words, you can use to quickly learn coding and documentation rules to maximize your payment for the services you provide.


Template Letters for Appealing Denied Claims   

These letters have been prepared to assist in appealing some of the most common denials experienced by emergency medicine practices. 


The Fundamentals of Reimbursement: What Every Graduating Resident Should Know Before Starting Practice   

As a recent residency graduate, you should have a thorough understanding of the basics of two important reimbursement issues: coding and billing.


Billing Hassles Log   

Provides a mechanism for practices to report denials from payers on processed claims.  

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