Payer downcoding programs
Level 4 and 5 visits automatically reduced by diagnosis-based policies. We appeal with the presenting complaint and MDM documented, and track payers that do it systematically.
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Emergency Medicine medical billing services
Emergency medicine billing is high volume, high acuity and heavily scrutinized: five E/M levels (99281–99285), critical care, procedures and the documentation to prove every one. Groups win or lose on leveling accuracy, procedure capture and a disciplined response to the denial patterns payers run against ED claims.
What makes emergency medicine billing different
General billers treat every specialty the same. These are the rules, code families and payer habits that decide whether emergency medicine claims pay the first time.
- ED E/M levels are selected by medical decision-making only, with no time option, and payers audit 99285 distributions closely.
- Critical care (99291) requires documented time and the exclusion of separately billed procedures from that time.
- Procedures — repairs, reductions, intubation, central lines, sedation — are separately billable and commonly missed in fast-moving charts.
- Some payers apply ED-specific policies, including downcoding programs based on final diagnosis rather than the presenting problem.
Denials we see most in emergency medicine
Every denial gets a root cause, a fix and a feedback loop, so the same denial stops coming back.
Missed procedures
Procedures performed but never charged. We audit charts against charges to capture them.
Critical care documentation
99291 denied for an unclear time statement. We flag before submission.
How Core MB bills for emergency medicine
A dedicated team that already knows your payers' rules, plus the reporting to prove it is working. Credentialing for new emergency medicine providers runs in the same system, tracked live in your client portal.
- Leveling review against MDM elements with group-level distribution monitoring.
- Chart-to-charge audit for procedure capture.
- Systematic appeals against payer downcoding, with reporting on which payers and policies drive it.
Everything in the service
The full revenue cycle as standard for emergency medicine practices, priced on what we collect for you. Take all of it, or start with one piece such as AR recovery or credentialing.
- Insurance verification and eligibility checks
- Charge entry and specialty-specific coding review
- Claim scrubbing and electronic submission
- Payer follow-up on every open claim
- Denial management and appeals
- Payment posting and reconciliation
- Accounts receivable recovery
- Patient statements and balance support
- Monthly reporting you can read in five minutes
- Provider credentialing and payer enrollment
Emergency Medicine billing questions
How are ED visits leveled?
By medical decision-making alone — the number and complexity of problems, data reviewed and risk. Time is not a factor for ED codes, so documentation of MDM is everything.
What is diagnosis-based downcoding?
A payer policy that reduces the E/M level based on the final diagnosis rather than what was evaluated. It is appealable, and we appeal it consistently with the presenting complaint documented.
Can you bill for ED procedures separately?
Yes. Repairs, reductions, sedation and lines are separately payable with proper documentation, and they are frequently missed in ED charting.
How do we get started with Core MB for emergency medicine billing?
Send us your specialty, provider count and monthly claim volume through the quote form and we will come back with a written proposal. Transitions run alongside your current billing so nothing is dropped, and credentialing for new emergency medicine providers can start at the same time.
More in primary and general care
Find out what your emergency medicine billing is leaving on the table
Send us a snapshot of your current billing and we will come back with a quote and a realistic view of recoverable revenue.