Denying Payment for Unnecessary Emergency Room Visits

KevinMD.com published an article on "Denying Payment for Unnecessary Emergency Room Visits".  This blog post highlighted Washington Medicaid Initiative which would deny Medicaid payments for unnecessary Emergency Room visits.

Some takeaways from the article were:

• Washington State is committed to pay for medically necessary care - but many patients go to the ER when they could just go to a primary care physician. 
• There is tremendous overuse and abuse of emergency rooms - at least $21 million dollars a year
• ER Physicians and Hospitals have had the state pay for non-medically necessary services in the Emergency Room.
• Everyone must be seen regardless of their ability to pay according to the EMTALA (Emergency Medical Treatment and Active Labor Act) of 1989.
• One idea that the state of Oregon did was assign a social worker to each of those patients who repeatedly go to the emergency room.  The intent of this is to divert patients away from the Emergency Room who they think are going for a "social problem". The time spent with the social worker costs less than what they would have to pay for the Emergency Room visit.

To view the full blog post, click here: Denying Payment for Unnecessary Emergency Room Visits

For additional billing and coding resources, please click the following link: Medical Reimbursement Resources Page