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CPT 99285, Emergency Department Visit

Emergency department visits for the Evaluation and Management (E/M)
of a patient in the emergency department, excluding critical care services.


Findings Related to CPT code: 99285...

Cited in Physician Management Company data:

Frequency of Denial
0 %
Days Delayed
0
Million Revenue Impact
$
  • Administrative Costs - The average administrative cost of reworking a claim once is $25.00 in administrative salary costs. Many claims may go through the process several times. For example, let’s say a practice file 1000 claims per month. 20% of those claims are denied (80% clean claims rate), which equals 200 claims at $25 each, or a conservative $5,000 in extra costs. This does not include office overhead, employee benefits, computer systems, clinician time, and electronic filing fees.
  • Missed Deadlines - Having the capacity to spend the time to rework denied claims is a common issue. Rejected claims can sit in a pile for too long and end up missing timely filing deadlines – ending in a total loss of revenue. When a claim is denied, it is as though it were never filed – the clock does not start over. If it is rejected twice, the situation is the same. When a backlog of denials is on someone’s desk, it is easy for some to get overlooked. Each payer sets its own timely filing deadline.
  • Rising Denials - Denial numbers are on the rise. An article in Modern Healthcare reports that 67% of healthcare leaders have seen an increase in denials. Many of these are “request for information” denials or the type that requires the clinical side to provide additional documentation.
  • Compliance - Ensuring that codes are assigned accurately and in compliance with coding guidelines and regulations set forth by organizations such as the Centers for Medicare & Medicaid Services (CMS) and the American Medical Association (AMA). Addressing concerns related to the correctness and specificity of codes assigned to medical procedures, diagnoses, and services to accurately reflect the patient's condition and the care provided.
  • Education - Providing ongoing education and training for coding staff to stay updated on changes in coding regulations, guidelines, and best practices, ensuring proficiency in accurate code assignment. Conducting regular audits of coding practices to identify coding errors, discrepancies, or areas for improvement, and implementing corrective measures as needed to maintain compliance and accuracy.
  • Software - Many healthcare organizations are using medical software with AI and Machine Learning to help staff members code correctly the first time. The right software will be intuitive for medical coders to use and will be regularly updated.
  • Outdated Manual - The American Medical Association (AMA) cites failure to regularly check National Correct Coding Initiative edits as one of the top medical coding mistakes to negatively impact healthcare organizations.
  • Poor Documentation - Documentation should be thorough as it ensures that every service is properly recorded and identified. This includes progress notes, authenticated medical records, and insight into intent to order services or procedures.
  • Under/Over Coding - Coding should indicate the exact level of service performed and documented. If codes that reflect these services are left out, however, it can be difficult to accurately convey the full extent of the services provided.

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• Unlock increased revenue with Rectifi's cutting-edge analytics
• Anticipate and Mitigate denials to get paid faster
• Elevate your financial outcomes through proactive decision-making
• Reduce friction and administrative burden within your organization
• Quickly understand and resubmit no-touch claims with the power of machine learning

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