Our department doesn't give appointments, but we did switch to outpatient billing status for our ESI 4's and 5's running through our Fast Track. We also see ~72% TNCARE.  You are correct that most payors will not want to pay for visits that are not seen as emergencies.  Although every state is different, if you do have to move to urgent care billing, look at negotiating for no denials, some age limitations and re-evaluate your criteria for what moves through that area.  If your reimbursement is changed you will want to try and minimize the impact by decreasing your LWBS, time spent on denials and improving your process flow through the area to decrease  time and cost.  Good Luck and invest in a good appointment scheduling program! 


Barry Gilmore,MD,MBA 
Chief,Division of Emergency Services 
Associate Chief of Staff 
Associate Prof. of Pediatrics 
Methodist-LeBonheur Children's Hospital 
Memphis, TN 38103 
[log in to unmask] 

----- Original Message -----
From: "Robert Flood" <[log in to unmask]> 
To: [log in to unmask] 
Sent: Monday, November 7, 2011 3:10:29 AM 
Subject: Re: Appointments in the ED 

Out hospital system has just announced that this service will be offered. 

In addition to the concerns expressed by Ernie, I have these additional 

1) Approximately 55% of our patients are ESI Level 4 and 5. This means that 
if we could figure out a way to implement this, we would have to make 
available "appointments" to more than 25,000 patient visits/year. 

2) Our population is approximately 70% Medicaid/Medicaid HMO. I am 
concerned that "scheduling appointments" will give the states just the 
excuse they need to decrease reimbursements to Hospitals for ED visits.  In 
other words, why should insurance companies pay ED fees for non-emergent 
patients who have "scheduled" appointments? 

I would appreciate hearing your thoughts regarding the scheduling 
"appointments" for pediatric patients in Emergency Departments. 


Bob Flood 
Division Director, Cardinal Glennon Children's Medical Center 
St. Louis, MO 

On Tue, Sep 20, 2011 at 7:46 AM, Ernest Bertha <[log in to unmask]>wrote: 

> Just a thought as I am reviewing some CME.... If patients make an 
> appointment in the ED, is the hospital and the ED doc still responsible 
> under EMTALA?  Obviously, if it is an appointment, no emergency medical 
> condition exists and therefore a MSE isn't required.  Just wondering how 
> this might/will affect this type of care in the ED? 
> Ernie 
> Ernest G. Bertha, MD, MBA, CPE, FAAP 
> Chief Medical Officer, Pediatric Services 
> Sheridan Healthcare Services, Inc. 
> 1613 North Harrison Parkway 
> Suite 200, SH-10 
> Sunrise, Florida 33323 
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