The Emergency Department is the front door of the hospital, but it is the hardest place to manage revenue. Emergency medicine billing must keep pace with high patient volume, complex documentation and frequently changing payer requirements. We help emergency groups reduce preventable billing errors, denials and delayed follow-up. You don’t need another generic billing vendor. You need a partner who understands the difference between a fracture reduction and a simple splint. Dastify Solutions helps reduce billing errors and denial rates for high-volume emergency groups.
Most billing errors aren’t just typos; they are systemic failures to understand emergency medicine workflows. Here is how we stabilize your cash flow.
The Documentation GapEmergency physicians document under intense time pressure. Critical-care claims may be missed when the record does not clearly support the patient’s critical condition, the physician’s work and the total qualifying time.
Documentation-Aligned E/M CodingWe select the ED E/M level supported by the documented medical decision-making. Claims are neither downcoded automatically nor raised to a higher level without support in the record.
The Eligibility BottleneckHigh patient volume creates a flood of eligibility errors, unverified coverage, and "medical necessity" pushbacks from payers.
Documentation and Procedure ReviewWe review the completed record for documented critical-care time and separately reportable procedures. We do not infer undocumented work, and time spent performing separately billed procedures is excluded from critical-care time.
Consistent Coding ReviewWe apply the latest Medical Decision Making (MDM) hierarchy strictly. If the data supports high complexity, we bill for it. We arm you with the documentation defense to back it up.
Pre-Submission ScrubbingWe deploy predictive denial analytics. We scrub every claim against Medicare NCCI edits and local MAC policies before it ever leaves the system. If it is not clean, it does not go out.
Emergency physician claims and hospital facility claims follow different coding and payment rules. We review professional E/M and procedure billing separately from facility levels, observation services and trauma-response charges so each claim reflects the correct billing entity and documentation standard.
We handle the full lifecycle, from the ambulance bay to the bank deposit.
Trauma & Critical Care Billing
For hospital outpatient facility billing, we review trauma-response claims for eligible trauma-center status, prehospital notification, revenue code 068X, qualifying critical care and the documentation required to report G0390.
Professional Emergency Medicine Coding
Our team includes CEDC specialists who review claims against current emergency department E/M requirements. For split or shared visits, we verify the billing practitioner, substantive portion, required documentation and claim modifier.
Observation Services Management
Navigating the blur between ED and Inpatient is difficult. We review current inpatient and observation E/M code families, same-day admission and discharge services, discharge management and the documentation supporting the patient’s status.
A/R Cleanup for Emergency Groups
Do you have a backlog? Our A/R team reviews aged balances, payer responses, filing limits and previous follow-up to determine which claims remain actionable.
Procedure & POCUS Billing
We review POCUS services for medical necessity, the examination performed, stored images, a documented interpretation and the appropriate professional or technical component.
The No Surprises Act affects patient cost-sharing and payment disputes involving many out-of-network emergency services. We support the administrative review and dispute workflow for eligible claims.
QPA Analysis
We audit the payer's "Qualifying Payment Amount" to spot underpayments.
IDR Arbitration
We manage the Independent Dispute Resolution portal, submitting batched disputes for underpaid claims.
Compliance
We support applicable No Surprises Act notices and billing protections for emergency services. Good Faith Estimates apply to scheduled or requested non-emergency services, not care received during an emergency encounter.
The regulatory environment shifts every year. If your current billing process is not updated for the latest Physician Fee Schedule, you are non-compliant.
| Clinical Scenario | Standard Billing Approach | The Specialized Approach |
|---|---|---|
| Critical Care | Misses the "total time" statement and bills as a standard ED visit. | Reviews the critical condition, qualifying physician work, total documented time and exclusion of separately billed procedure time. |
| Fracture Care | Bills only the splint application. | Determines whether the physician provided definitive fracture care or temporary stabilization and applies bundling and global-period rules accordingly. |
| Trauma Activation | Ignore the "pre-hospital notification" requirement. | For eligible facility claims, verifies prehospital notification, trauma-center status, revenue code 068X, critical-care requirements and G0390 support. |
| Moderate Sedation | Misses the distinct "intra-service time" documentation. | Reviews patient age, provider role, intra-service time, monitoring and the procedure performed before assigning sedation codes. |
| Sepsis Management | Downcodes due to vague "fever" diagnosis. | Sends a neutral clarification request when the clinical indicators and documented diagnosis do not align. The provider retains responsibility for the diagnosis. |
Get a forensic audit of your last 50 claims and see exactly how much you are leaving on the table.
Learn More About Us
We monitor the CMS guidelines closely. Currently, the substantive portion can be defined by more than half of the total time or a distinct Medical Decision Making (MDM) contribution. We verify that the physician and APP are in the same group, identify who performed the substantive portion, confirm the required documentation and apply the appropriate claim modifier. Critical-care split/shared services are determined by time.
While we focus on billing, our analytics identify bottlenecks in Triage that cause LWBS. We provide data that helps ED Directors staff more efficiently. Our reporting can identify LWBS patterns by arrival time, wait time and service period. We do not treat registration or triage alone as a billable professional E/M service.
Yes. Whether you are a standalone democratic group or a hospital-employed roster, our emergency physician billing services are scalable. We handle the credentialing, the contracting, and the cash flow.
