ED Coding and Reimbursement Alert

Emergency departments should make prior arrangements to alleviate the problem of coding for inmates and arrested suspects.

ED clinicians see all types of unusual situations not common to healthcare providers in other specialties. Among these are visits initiated by law enforcement personnel who bring people in custody into the department for treatment. Often, a suspect may need medical treatment. For example, a suspected drunken driver is arrested, but the police need to be sure the person has not been injured and can be incarcerated. Or, a person already in jail requires medical treatment.

The police often take these people to the nearest ED, so how do you charge for these services? The patient did not come to the department seeking care. Should you bill the patient? Should you bill the city? How are these services reported?

EDs have come up with a variety of arrangements to handle the challenge. Sometimes, they have contracted agreements to bill the municipality or county for the medical treatment. Some bill the patient, or the patients insurance if the patient has it. Some groups have policies that incorporate both of these approaches.

Jackie Davis, president and CEO of Term Billing Inc., an emergency physician billing company in Arlington, TX, says that if the patient is brought to the ED for treatment and was not previously in police custody, then most of her physician groups charge the patient or patients insurance. It is our position that the patient is responsible for the charges, she says.

Term has had one complaint from a patient who felt it unfair to be charged for the visit, since he did not initiate the service, but, overall, they have not had major problems.

Charging the City or the Patient

However, for patients already in police custodysuspects in jail awaiting trial, for examplethe group charges the city or county. Their reasoning is that the governmental body is responsible for the prisoners medical care.

The policy is different for clients of Reimbursement Technologies Inc., an ED professional coding and billing company based in Blue Bell, PA.

It varies from group to group, but most charge the patient, says Stephanie Gaboda, billing manager for the company. For patients who are incarcerated, many EDs have worked out contracted arrangements with the jail or prison for the inmate medical care.

These arrangements may be a flat fee per encounter, or the facility may be billed the normal hospital and physician charges, the way a patient or third-party payer would be billed, she says.

Crime Victims are not Charged

Even if persons accused of crimes are billed for their medical care, most states have money set aside to reimburse EDs for providing care to crime victims, particularly rape and domestic violence, says Daryl LaRusso, MD, a practicing emergency physician in West Virginia.

Even if the state has set aside money, many departments treat the victims without charging them, says LaRusso.

Our state has recently set up a program that pays a minimal fee for treatment of rape victims, he adds. These services take up a lot of time and resources, and often require the presence of a social worker, so it is good to at least get something back to reimburse the costs. We would do it anyway, but I think it is good that the program is in place.

ED groups should check their individual state laws for availability of such programs.

Gaboda acknowledges that there is money in most places set aside for paying for the treatment of crime victims, but, usually, the victim must request this aid first, she says.