Duane C. Abbey

Coding, Billing & Reimbursement for Non-Emergency Care in the ED

Presenter : Duane C. Abbey, PhD
Event Date : 04/25/2019
Time: All Day Long
Duration : 90 Minutes



Product Description

Emergency departments in hospitals are meant for people with emergency care needs. But because of its 24 hours availability, it is more used by non emergent cases. The percentage of cases for emergent care needs is much lower than those with non emergent needs which is creating many challenges for the healthcare organizations in terms of increased cost and negative impact on care coordination. In this webinar, our expert will be dealing with the reasons for so much non-emergent care in the ED,ways through which hospitals EDs coping with increasing volumes of uninsured that require non-emergent care, role of EMTALA (Emergency Medical Treatment and Labor Act) in providing non-emergent care and much more.

Most frequently asked questions will also be addressed by the speaker like:

  • That is the difference between emergent, urgent and clinical care in the ED?
  • What is the difference between emergent, urgent and clinical care in the ED?
  • What impact does the lack of primary care services have on a hospital’s ED?
  • What steps can hospitals take to reduce non-emergent care in the ED?
  • How do Medicare and other third-party payers react to non-emergent care in the ED?
  • What about provider-based Urgent Care Centers?
  • What about freestanding EDs?

Session Objectives:

  1. To review the levels and types of services in the ED.
  2. To differentiate between emergent, urgent and clinical levels of services.
  3. To understand the reasons for increasing volumes of urgent and clinical level services in the ED.
  4. To appreciate how EMTALA rules and requirements dovetail with non-emergent levels of care.
  5. To understand the increasing needs for fast-tracks and establishment of urgent-care clinics.
  6. To understand pressures on Medicare and other third-party payers to create special coding, billing and reimbursement processes for non-emergent care in hospitals’ EDs.
  7. To appreciate surgical services and the associated coding and billing for such services.
  8. To understand when Urgent Care Clinics are EDs
  9. To appreciate the role of freestanding EDs
  10. To examine several case studies illustrating the challenges for non-emergent care in hospitals’ EDs.

Session Agenda:

  1. Overview of ED Services
    1. Emergency Care Including Trauma Services
    2. Urgent Care
    3. Clinical Services Provided in the ED
    4. Freestanding EDs
  2. Growth in Volume of Non-emergent Care
    1. Underinsured
    2. Uninsured
    3. Lack of Accessible Primary Care
  3. EMTALA Considerations
    1. EMTALA Obligations
    2. MSE – Medical Screening Examination
    3. Care vs. Stabilize and Transfer
    4. Qualifying Nurses for Performing MSEs
    5. Sending Patients to Clinic for Services
  4. Hospital Organizational Structuring
    1. Fast-Tracks inside EDs
    2. Urgent Care Clinics
    3. Provider-Based Walk-In Clinics
    4. Compliance Concerns
    5. Opt-Out Physicians and Practitioners
  5. Coding and Billing Considerations
    1. Use of Emergency Level Codes
    2. Use of Clinic Level Codes
    3. Chargemaster Development for Urgent and Clinic Care
  6.  Predicting the Future
    1. Medicare Directions
    2. Private Third-Party Payer Approaches
    3. Payment System Changes
  7. Special Case Studies
  8. Sources for Further Information
Related Courses:

Suggested Attendees:

  • ED Personnel
  • Coding Personnel
  • Billing and Claims Transaction Personnel
  • Chargemaster Coordinators
  • Utilization Review Personnel
  • Internal Audit Staff
  • Financial Analysts
  • Compliance Personnel
  • Physicians
  • Non-Physician Practitioners 

About the Presenter:

Duane C. Abbey, PhD, CFP, is a management consultant and president of Abbey & Abbey Consultants, Inc., a consulting firm specializing in healthcare and related areas. Duane earned his graduate degrees at the University of Notre Dame and Iowa State University and has more than 20 years of experience as a consultant. Dr. Abbey works extensively in all areas relating to compliance reviews, coding, billing and reimbursement with particular emphasis on the chargemaster and outpatient payment. His consulting activities include hospitals and physicians based clinics.

In addition to his consulting practice, Dr. Abbey also teaches workshops and makes presentations on a regular basis. He has taught at the University level and speaks nationally. He is a regular presenter for hospital associations, medical societies, Boards of Trustees and various other organizations and groups. In addition, professional societies such as HFMA use Dr. Abbey’s services to present seminars and workshops.

Dr. Abbey is a nationally recognized expert in payment systems. A special area of expertise includes APGs/APCs. He is recognized as the leading expert in the nation in APGs/APCs by the thousands who have attended his seminars, read his publications and/or contracted for his services. Attendees at these seminars over the years have included personnel from hospitals, clinics, integrated delivery systems and multiple consulting firms.

Dr. Abbey is also the author of numerous articles and books including: Compliance for Coding, Billing & Reimbursement, Outpatient Services: Designing, Organizing & Managing Outpatient Resources, ChargeMaster: Review Strategies for Improved Billing and Reimbursement, Ambulatory Patient Group Operations Manual, published by McGraw-Hill and Non-Physician Providers: Guide to Coding, Billing & Reimbursement, Chargemasters: Strategies to Ensure Accurate Reimbursement and Compliance, and Emergency Department Coding & Billing: A Guide to Reimbursement & Compliance published.

After Registration

You will receive an email with login information and handouts (presentation slides) that you can print and share to all participants at your location.

System Requirement

Operating System: Windows any version preferably above Windows Vista & Mac any version above OS X 10.6
Internet Speed: Preferably above 1 MBPS
Headset: Any decent headset and microphone which can be used to talk and hear clearly

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For more information you can reach out to below contact:
Toll-Free No: 1-302-444-0162
Email: [email protected]

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