Episode 372 - #TerryTuesday - Emergency Room Compliance Issues

Summary

In this episode of Terry Tuesday, Sean and Terry discuss the challenges and insights from recent audits in emergency rooms, focusing on overutilization of services, critical care documentation, and the importance of accurate medical records. They highlight the need for compliance in healthcare practices and the implications of poor documentation on patient care and billing.

Takeaways

• Terry recently completed a large paper audit with significant findings.
• Emergency rooms often overutilize diagnostics and labs for simple complaints.
• There is a lack of understanding of medical necessity in ER documentation.
• Critical care documentation is often misapplied in ER settings.
• Standard orders for tests can lead to unnecessary costs and audits.
• Providers must analyze and incorporate data from external sources in their documentation.
• Overutilization can lead to targeted probes and audits by payers.
• Healthcare providers need to be aware of their billing patterns and compliance.
• Documentation must reflect the medical necessity of services rendered.
• Providers on salary still need to be accountable for their documentation.