How much do EDs collect - on average?

[MCATISEZ]

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Totally out of curiosity and to better understand healthcare costs in the US. I haven’t been able to find a solid number. From what is billed, what percentage do emergency departments typically collect? With high ED costs and my experiences in the ED, I have to wonder. No political discussions please, but I want to know the hard facts.


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[darkjedi]

Billing is incredibly complex, especially so in the ED. Each insurance company will pay a certain rate according to their specific contract with a hospital.

There are several billing levels ranging from 1 to 5, that reimburses anywhere between 0.6 to ~5 RVUs. It's estimated that each RVU reimburses about $36 according to CMS/Medicare. This doesn't include any of the medications or procedures that you may have done during your visit as well.

 

[MCATISEZ]

Billing is incredibly complex, especially so in the ED. Each insurance company will pay a certain rate according to their specific contract with a hospital.

There are several billing levels ranging from 1 to 5, that reimburses anywhere between 0.6 to ~5 RVUs. It's estimated that each RVU reimburses about $36 according to CMS/Medicare. This doesn't include any of the medications or procedures that you may have done during your visit as well.

No kidding. I’d love to learn more about medical billing and the fiscal aspect of healthcare. Where does that happen for most physicians? Mostly on the job and through research so they will understand it at a level that will benefit them through the course of their practice? I feel like it is vital in making intricate sense of healthcare disparities.


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[darkjedi]

No kidding. I’d love to learn more about medical billing and the fiscal aspect of healthcare. Where does that happen for most physicians? Mostly on the job and through research so they will understand it at a level that will benefit them through the course of their practice? I feel like it is vital in making intricate sense of healthcare disparities.


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The vast majority of physicians won't get that kind of training during their residencies unless they actively seek them out. Most learn it once they are attendings and are trying to maximize their RVU's per hour to hit certain metrics or get bonuses.

The problem with learning about a lot of this billing is that it's all subject to change at a moments whim. It is also worth reiterating the fact that, while medicaid/medicare reimbursement is relatively transparent, billing with private insurers is completely and utterly nonsensical.

 

[STcmOCSD]

In addition to contracts made with insurance companies, the cash pay price is approximately 10% of the total bill. One of two things happen.

1) patient pays and hospital still makes money, because the 10% is still more than the actual cost of procedures.

2) patient doesn’t pay and hospital writes off the full amount, not what they charged patient.

Either way, hospital billing is incredibly complex as mentioned above.

 

[SpartanDOnoharm]

To give you an idea of how complex ED billing is, if nurses at my hospital don’t chart exactly how many mL of an infusion have gone in the ER doesn’t receive any money for it. It goes inpatient instead.