Protect ED facility-level accuracy, capture documented trauma and observation services, reduce UB-04 leakage, and keep high-volume emergency revenue moving.
Emergency Department facility billing represents the hospital resources used during an emergency encounter: nursing intensity, monitoring, medications, supplies, diagnostic services, procedures, room resources, and other facility services.
It is separate from the emergency physician's professional fee.
Hospital ED services are generally reported on the institutional claim using appropriate emergency-department revenue codes, while professional services follow the professional billing pathway.
The same encounter can therefore generate two very different revenue-cycle responsibilities: one for the physician and one for the facility.
Emergency departments combine:
For Medicare hospital outpatient reporting, hospitals use their own documented facility-level guidelines that should reasonably relate to resource use and be applied consistently. There is no single nationally mandated ED facility-leveling point system that every hospital must use.
That makes documentation integrity and consistent application of the hospital's own methodology essential.
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Institutional revenue loss often begins upstream—in documentation, classification, charge capture, claim structure, status, payer logic or posting—before it appears as a denial or aged balance.
If facility levels are tied mechanically to the physician's professional code instead of the hospital's documented facility resources, the claim can misrepresent the actual encounter. The objective is neither automatic up-leveling nor defensive down-coding. It is consistent application of the hospital's written facility-leveling policy to the documented resources used.
HCPCS G0390 has specific Medicare claim conditions and is not a generic trauma fee that can be billed whenever a trauma patient arrives. For applicable Medicare claims, trauma-response reporting requires the relevant trauma revenue code and qualifying critical-care reporting on the same date of service. Documentation and claim configuration must support the service.
HCPCS G0378 represents hospital observation service per hour. Medicare observation time begins only after the appropriate order and initiation of observation services, and the billed time must follow CMS counting rules. Missing order times, start/stop documentation, or incorrect overlap can reduce valid observation units or create compliance risk.
Splints, laceration services, ECGs, point-of-care testing, injections/infusions, imaging, respiratory treatment, and other ED services can be missed when the clinical record, charge capture, and billing system do not reconcile.
ED encounters can move to observation or inpatient status. Incomplete communication between utilization review, registration, nursing, coding, and billing can create duplicate charges, missing hours, incorrect bill types, or status-related denials. ---
CareMedox ED review can examine:
A strong ED revenue cycle depends on fast claim movement without sacrificing documentation control.
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CareMedox works the root cause and the affected inventory together so the institution is not forced to repeat the same correction claim after claim.
Claims are checked against the hospital's documented, consistently applied facility-level methodology and available nursing/resource documentation.
G0390 eligibility, trauma revenue-code reporting, critical-care relationship, and supporting documentation are validated before or during claim audit.
Order time, start/stop time, qualifying observation duration, exclusions/overlap, and claim units are reconciled.
Charge capture is compared with documented procedures, diagnostics, medications, and supplies to identify missing lines.
ED, observation, and inpatient status changes are reconciled against orders, utilization review, bill type, and claim timeline.
Denials are grouped by registration, eligibility, authorization, coding, medical necessity, claim edits, and payer behavior so repetitive defects can be corrected at the source.
These are CareMedox operating targets after onboarding and workflow stabilization—not guaranteed payer outcomes.
98%+ first-pass clean institutional claim target
Under 2% preventable front-end / clearinghouse rejection target
Approximately 5–6% overall denial-rate target
95%+ target for pre-bill identification of documented, separately reportable ED services within the agreed audit workflow
Active 60/90/120+ ED AR prioritization
The 95% capture target applies to services that are actually documented and available to the agreed pre-bill review process. It is not a promise to create charges that the medical record does not support.
Certified coding review is connected with senior revenue-cycle operations, detailed reporting, aging control and transparent reconciliation.
CareMedox connects certified coding review with senior professionals experienced in claim scrubbing, payment posting, denial handling, reconciliation, and AR.
The institutional workflow is built around a 98%+ first-pass clean-claim target after onboarding and stabilization.
CareMedox aims to control avoidable denials close to the source rather than building an ever-larger downstream denial department.
Where CareMedox has access to the required registration, coding, CDM, and payer information, the goal is to drive preventable clearinghouse/front-end rejects below 2%.
Aging is prioritized by financial impact, filing/appeal deadline, denial reason, and recoverability.
Hospital reporting should show payer behavior, denial root cause, claim status, payment variance, posting corrections, aging, and recovery—not just a monthly collection total.
The senior CareMedox team has experience across more than 15 platforms and can work with different clearinghouses.
Where a claim becomes nonrecoverable solely because of CareMedox negligence, the CareMedox TFL accountability policy applies according to the executed agreement and applicable Medicare-fee-schedule basis.
The audit is tailored to the facility type and focuses on what is wrong, why it is happening, what is financially exposed and what needs to change upstream.
Request a 30-Day ED Facility AuditCareMedox keeps billing, coding, claim, payer and AR work aligned while clinical or legal judgment remains with the institution's authorized personnel when required.
No. Hospitals should have their own documented facility-level methodology. CareMedox can review whether the facility is applying that methodology consistently to the documented resources used.
No. Medicare applies specific claim requirements. CareMedox validates the trauma response, revenue-code, critical-care, date-of-service, and documentation requirements before treating the service as billable.
Observation is time-based. CareMedox reviews physician orders, initiation time, stop time, overlapping services, units, and claim reporting rather than assuming every hour spent physically in the hospital is billable observation time.
Yes. CareMedox prioritizes 60/90/120+ balances based on appealability, timely-filing status, payer, value, and root cause. ---
Move between related facility workflows without leaving the institutional RCM cluster.
Emergency care moves quickly. The billing system behind it needs to be just as fast—and much more controlled.
A shorter first step when you want to discuss a billing, RCM, AR, denial, reporting or payer-workflow concern without completing the full inquiry form.