/https://static.texastribune.org/media/files/4ce5eff9666a129715fd712311cea53c/20200801-patient-disclosure-statement-F.jpg "Er Copay Meaning")
Please - any guildline advice on providers billing an ER charge with OBV charges.
---- OBV = observation.
We have a discussion in regards to if it matters when a patient is seen less than 24 hours - when they come in by ER. Is this claim reimbursed has an ER, or is the claim consider OBSERVATION since a observation code was bill.
Most carriers that I have worked with guidelines states that as long as an a 760 - observation is billed then the claim is considered observation, not ER. BUT, does time matter?
If a patient status changes to OBV and is in OBV for 3 hours, or 6 hours, less then 24 hours, is this claim considered still an ER bill? Since the OBV hours were not 'up to 24 to 48 hours' does this mean the claim is an ER and not a OBV stay?
The patient is moved to OBV, the status changes correct?
Or does it matter on the REV code / Or is this coding/reimbursement dicated by the carrier? Meaning that each carrier is different - there is no global guildelines they have to follow.
760
Treatment/observation room
761
Treatment room
762
Observation room
769
treat/observation room - other
Thank you so very much for your time.
TiffanyM.
Copay Meaning Healthcare
Er Copay Meaning
When deciding whether to go to the hospital’s ER (the hospital’s emergency department) or a freestanding ER, it really comes down to distance. The purpose of a freestanding ER is to provide potentially life-saving care closer to home. When hospitals are not nearby, this can mean faster care for you and your loved ones when minutes matter. If you are insured, your health insurance company will require a co-pay amount for emergency room treatment, which will vary based on your health insurance plan. Under the Affordable Care Act Patient’s Bill of Rights, as of September 23, 2010, insurance companies are not allowed to charge higher co-pays for out-of-network hospitals and patients are not required to get pre-approval for emergency care. Your copay or coinsurance for ER visits will generally be higher than the copay for doctor’s or urgent care center visits. There may be two separate charges – one from the emergency room, and one from the physician who treats you. A copay after deductible is a flat fee you pay for medical service as part of a cost-sharing relationship in which you and your health insurance provider must pay for your medical expenses. Deductibles, coinsurance, and copays are all examples of cost sharing. The following tables provide examples of cost-shares or copayments and annual deductibles for families who use civilian providers and facilities under each of the three Tricare options.