Emergency Medicine Billing That Captures Every Dollar You've Earned

Emergency billing is built on the ED E/M levels 99281–99285, critical care 99291 (first 30–74 minutes) and add-on 99292, and frequent same-day procedures — laceration repair, fracture care, intubation — that require modifier 25 on the E/M. Level selection is heavily audited because emergency medicine has no "new versus established" distinction and relies entirely on medical decision-making and risk; under-documentation pushes a true 99285 down to a 99283 and leaves money on the table, while over-coding invites recoupment.

Emergency medicine carries the largest out-of-network exposure of any specialty: under EMTALA you must treat every patient regardless of network status, so a large share of claims are out-of-network by definition. The No Surprises Act now routes much of this through the Qualified Payment Amount and IDR, and payers routinely anchor low. Facility (hospital) and professional (physician group) components are billed separately, and the pro-fee side is where independent emergency groups recover or lose the most.

REL1EF defends ED E/M and critical-care levels with medical-decision-making documentation, captures same-day procedures with correct modifier 25, and runs out-of-network claims through NSA-compliant IDR — benchmarking against the QPA and UCR data to beat initial payer offers. Root-cause denial work targets the emergency-medicine staples: downcoding edits, critical-care time documentation, and modifier-25 bundling denials.