Under-coded visits
Charts that support 99285 get billed as 99284. Across thousands of visits, one level is a large share of your income.
Emergency medicine billing & RCM · California
Emergency Medicine Billing Services for California ED Physician Groups
Professional ER billing and coding that captures every supported level, every documented critical-care minute, and the payment California law says your group is owed.
- ED coding leveled by medical decision making, not guesswork
- Critical-care time captured to the minute and documented for audit
- HMO, PPO, Medi-Cal and self-pay recovery built around California emergency-payment law
HIPAA safeguards and BAAProfessional ED claims (POS 23)San Diego, CA
0 days
AB 3275 clock to pay, contest or deny a complete claim
0% / yr
Interest on late payments from DMHC-regulated plans
0%
Treat-and-release ED visits with Medi-Cal as expected payer
0%
Rise in median visits per ED station, 2021–2023 (HCAI)
Your physicians make high-stakes decisions every few minutes. Your billing should keep up. California Billing Services codes and bills professional emergency department claims for ED physician groups across California, from Level 1 visits to multi-hour critical care, and follows each claim until it is resolved.
Where revenue leaks
The revenue ED groups lose without a specialist
Emergency medicine loses money in ways most billing companies never see. Your group treats every patient who walks in, regardless of insurance, as EMTALA and California Health and Safety Code §1317 require. That leaves the billing team to recover payment after the fact from HMOs, PPOs, Medi-Cal plans and self-pay patients, often without a contract in place.
Lost critical-care time
If minutes aren't documented, 99291 drops back to an E/M level, and 99292 is never billed.
Unbilled procedures
Laceration repairs, splinting, intubations and bedside ultrasounds go unbilled, or get billed without modifier 25 and are denied.
Underpaid non-contracted claims
HMOs may pay non-contracted ED physicians less than California law requires, and nobody appeals.
Charge lag
Claims sit for weeks waiting on charts or attestations.
Volume makes every leak bigger. HCAI data show the median number of visits per ED treatment station in California rose 18% between 2021 and 2023.
Full-cycle RCM
Emergency medicine billing services we provide
We provide full-cycle revenue cycle management for emergency medicine, or the single piece your group needs most.
ED coding and chart abstraction
E/M levels, critical care, procedures, observation and diagnoses, coded from the physician's note by ED-trained coders.
Explore serviceCharge entry and claim submission
Professional claims (CMS-1500/837P, place of service 23) submitted promptly once the chart is final.
Explore serviceEligibility and retro-eligibility
Coverage found after the visit, including Medi-Cal and coordination of benefits for patients who arrived without an insurance card.
Explore serviceDenial management and appeals
Prudent-layperson appeals for "non-emergency" denials, level-downgrade appeals, and medical-necessity reviews.
Explore serviceNon-contracted and out-of-network recovery
Reasonable-and-customary appeals, No Surprises Act negotiation and federal IDR.
Payment posting and underpayment tracking
ERA lines checked against contract rates or reasonable-value benchmarks.
Self-pay and patient billing
Clear statements, charity and financial-assistance screening, and respectful follow-up.
Third-party liability
Motor-vehicle, workers' compensation and lien claims.
Provider documentation feedback
Coding reports by physician, showing what the chart was missing.
Credentialing and enrollment
New physicians and APPs enrolled with Medicare, Medi-Cal and commercial plans.
Explore serviceWe bill for hospital-based EDs, hospital-affiliated off-campus (freestanding) EDs, trauma centers and ED groups that staff several facilities.
Built around the ED chart
Every Level Starts With the Physician's Note
Medical decision making, critical-care time and procedures are captured from the documentation your physicians already write, and fed back to them as coding feedback.
ER billing and coding
ER billing and coding built on MDM and critical-care time
ED coding is the heart of emergency medicine billing, and it follows its own rules.
ED visits (99281–99285)
Leveled on medical decision making alone; time does not count. Coders score the number and complexity of problems, the data reviewed and the risk of management, then pick the level the chart supports. No up-coding, and no money left behind.
Critical care (99291, 99292)
Billed on time alone. 99291 covers the first 30–74 minutes. Medicare allows 99292 from 104 total minutes, while CPT allows it from 75, so each payer is billed by its own rule.
ED visit plus critical care
When critical care follows an ED evaluation, both can be supportable if they are documented separately. Every case is checked.
Procedures and modifier 25
Modifier 25 goes on the E/M when the work is significant and separately identifiable, and NCCI edits are applied before the claim goes out.
Split/shared visits
Visits shared between physicians and APPs carry modifier FS, billed under the clinician who performed the substantive portion.
Observation and admissions
99221–99223 and 99234–99236 coded correctly when your physicians admit or observe.
California emergency payment law
California emergency payment law, applied to your claims
California gives emergency physicians stronger payment rights than most states, but only if the billing team uses them. We build them into every claim.
01
HMO patients: reasonable and customary value, no balance billing
Under Health and Safety Code §1371.4, Knox-Keene health plans must pay for emergency services even without a contract. Non-contracted ED physicians are owed the reasonable and customary value of the service, and DMHC regulations set out how that value is determined. Since Prospect Medical Group v. Northridge Emergency Medical Group (2009), ED physicians cannot balance bill HMO patients, so any underpayment has to be recovered from the plan, through documented appeals and, when needed, a DMHC provider complaint.
02
PPO and self-funded plans: the No Surprises Act
For PPO, insured and self-funded plans, the federal No Surprises Act limits patient cost-sharing for out-of-network emergency care to in-network amounts. When the plan's initial payment is too low, we open negotiation and take the claim to federal Independent Dispute Resolution if it is worth pursuing.
03
AB 3275: the 30-day payment clock
Since 1 January 2026, California health plans and insurers, including Medi-Cal managed care plans, must pay, contest or deny a complete claim within 30 calendar days. Late payments owe 15% a year in interest from DMHC-regulated plans and 10% from CDI-regulated insurers. We track claims against that clock and follow up on interest owed.
04
Medi-Cal: your largest treat-and-release payer
Medi-Cal is the expected payer for 44% of California ED visits that don't lead to an admission. Each Medi-Cal managed care plan, such as L.A. Care, IEHP, Health Net, Molina or Partnership HealthPlan, has its own claims rules. Fee-for-service claims must be filed within six months. We keep plan-by-plan rules current to protect timely filing.
Sources: DMHC APL 25-007 (AB 3275), CMS physician fee schedule and HCAI ED data.
Not sure what your group is leaving on the table? Share recent ED charts and remits, and we can review your level distribution, missed critical care and underpaid HMO claims.
Step by step
How we take over your ED billing
Your billing never stops during the switch.
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Discovery
We review your payer mix, contracts, EHR and current A/R, and sign the BAA.
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System access and workflow
We connect to your EHR and clearinghouse, map charge flow and set coding rules for each physician.
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Parallel coding
We code alongside your current team so you can compare results before we take over.
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Go-live
New claims move to us. Legacy A/R is worked down at the same time.
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Monthly review
You get a scorecard and a review call every month.
Reporting and visibility
What you see every month
Each monthly dashboard tracks the metrics that show where ED revenue is captured or lost. Targets are agreed with your group during scoping.
| Metric | What the report shows |
|---|---|
| Charge lag | Days from date of service to claim, by physician and facility |
| E/M level distribution | Your level mix compared with national ED benchmarks |
| Critical-care capture rate | Share of critical-care encounters billed with supported time |
| Clean-claim rate | Claims accepted on first submission |
| Denial rate | Denials grouped by payer and root cause |
| Days in A/R | Time from billing to payment, month by month |
| Payment per visit by payer | Average reimbursement per ED visit, by payer |
| HMO underpayment recovered | Amounts recovered through reasonable-value appeals |
Claim-level follow-up
From the Remit Back to the Chart
Payments, denials and underpayments are reviewed line by line, so recovery work and physician feedback are based on what payers actually did.
Systems and payers
EHRs and payers we work with
Hospital EHR access and payer arrangements are confirmed during scoping.
EHRs
Payers
- Medicare (Noridian JE)
- Medi-Cal fee-for-service and managed care
- Anthem Blue Cross
- Blue Shield of California
- Kaiser Permanente (non-contracted emergency claims)
- Health Net
- Molina
- L.A. Care
- IEHP
- UnitedHealthcare
- Aetna
- Cigna
- Humana
- TRICARE West
- Workers' compensation carriers
- Auto insurers
Emergency medicine billing services provider
Why California ED groups outsource to California Billing Services
You want an emergency medicine billing services provider that knows California, not a national vendor reading from a script.
California-first
Our team works with the same state laws, Medi-Cal plans and HMO groups your patients use.
ED-focused coding
Your charts are coded by people trained on emergency department documentation and leveling rules.
Pricing that fits your group
Discuss a quote based on visit volume, payer mix and scope, with fees and terms agreed in writing.
Full transparency
Claim-level detail and regular reporting, with a clear point of contact.
Compliance first
HIPAA safeguards, BAA, coding audits, and documentation feedback that protects your physicians.
Related: ASC billing · Radiology billing · Urgent care billing · Denial management · Credentialing
Your next step
Your physicians handle the emergencies. We'll handle the billing.
Your physicians handle the emergencies. We'll handle the billing. Request an ED revenue review and see what accurate emergency medicine billing is worth to your group.
FAQ
Emergency medicine billing: your questions answered
Emergency medicine billing services manage the professional revenue cycle of an ED physician group: coding ED visits, critical care and procedures, submitting claims, recovering payment from HMOs, PPOs, Medi-Cal and self-pay patients, and appealing denials.
Can't find what you're looking for? Contact our billing specialists