In August 2020, the Centers for Medicare and Medicaid Services (CMS) released the proposed Medicare annual payment rule for 2021. This rule proposes policies for the Medicare physician fee schedule (PFS). The proposed 2021 Medicare emergency medicine conversion factor is 10.6% below 2020. This is largely due to the CMS decision to increase reimbursement for office and outpatient evaluation and management (E/M) services for 2021.

Despite Challenges, How Can Emergency Medicine Providers Maximize Revenue?

Looking forward into 2021, emergency medicine providers anticipate a growing number of uninsured patients due to higher unemployment rates caused by COVID-19. What can providers do to maximize revenue from all patient encounters?

• Optimize revenue cycle management (RCM) best practices.
• Deploy insurance discovery and demographic verification to maximize the ability to be reimbursed by payers.
• Implement adaptive financial assistance and charity screening.
• Evaluate staffing costs and alternative staffing options, e.g., employees versus contract staff.
• Prepare to request subsidies from their affiliated hospitals to continue providing the quality care the community needs.
• Expand into urgent care and telehealth.
• Directly contract with local employers (i.e., when employers are the payer) as an additional source of revenue.
• Consider risk-based contracts, in which the provider has a financial incentive to reduce the number of emergency visits by at-risk patients (“frequent flyers”), while delivering the same quality of care.

Many of the increasing number of uninsured patients do not have a primary care physician and go to the emergency room for non-emergent care. More uninsured patients and more unemployed patients may force high-volume emergency departments to reduce clinician hours. Emergency departments are expected to continue providing quality care to the community with significantly lower revenue to support them.

It is important for emergency physician groups to maximize payer reimbursement in 2021. While collecting from payers has its own set of challenges, collecting from an increasingly financially at-risk patient population is much more difficult. There are technology capabilities available that can have a positive effect in counteracting the proposed 2021 Medicare PFS cuts.

Read the full article for tips for emergency departments preparing for the rest of 2021 and to learn more about the capabilities available to support emergency medical departments in maximizing revenue.