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Report Charges Appropriately for Type B Emergency Departments
Ann Florer, RN, CCS-P
Corporate Compliance Analyst
Type B provider-based Emergency Departments (EDs) must meet at least one of the following requirements:
It is licensed by the State in which it is located under applicable State law as an Emergency Room or Emergency Department, and open less than 24 hours a day, 7 days a week; or
It is held out to the public (by name, posted signs, advertising or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment, and open less than 24 hours a day, 7 days a week; or
During the calendar year immediately preceding the calendar year in which a determination under this section is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment, regardless of its hours of operation.
In the 2007 OPPS Final Rule, the Center for Medicare and Medicaid Service (CMS) created codes G0380-G0384 in order to report these encounters and to serve as a vehicle to capture median cost and resource differences among visits provided by Type A emergency departments (operate 24/7), Type B EDs and clinics. CMS believes that hours of operation significantly impact hospital resource costs and that it is more costly to operate a department with full capabilities 24 hours a day than to operate with full capabilities 12 hours a day.
In the 2007 OPPS Final Rule, CMS stated that for facilities assigning visits in Type B EDs, they expect hospitals to adjust their charges appropriately to reflect differences in Type A and Type B EDs. In the 2008 OPPS Proposed Rule, CMS has repeated this directive and stated that 2009 rule making will session will be the first year they will have cost data for their analysis to determine if an alternative payment method is warranted for Type B ED.
Additional information pertaining to Type B EDs can be found at the following CMS Web site: http://www.cms.hhs.gov/OpenDoorForums/18_ODF_Hospitals.asp
The information contained herein is provided for informational and educational purposes only, and nothing contained herein should be construed as advice. All information contained herein is obtained by LYNX Medical Systems (LYNX) from sources believed by LYNX to be accurate and reliable. Because of the possibility of human and mechanical error as well as other factors, LYNX is not responsible for any errors or omissions. LYNX makes no representations and disclaims all expressed, implied, and statutory warranties of any kind to user and/or any third party including warranties as to accuracy, timeliness, completeness, merchantability or fitness for any particular purpose.