Egregious Physician and FSED Charges Raise Alarms

By Cynthia Swanson, RN, CPC, CEMC, CHC, CMPA, Vice President of Audit Services

Freestanding emergency departments (FSEDs) have evolved from a niche access point in healthcare to a fast-growing sector. They operate in at least 32 states and saw a 75% growth rate ahead of the pandemic. Today, high concentrations of these facilities exist in states such as Texas, Arizona and Colorado.

But what does the spread of FSEDs mean for the overall cost of healthcare? In practice, FSED billing can resemble — and be priced like — a hospital emergency department even when treatment is relatively straightforward.

That’s why our audit team zoomed in on real physician and facility claims at FSEDs. We analyzed emergency medicine services reported/billed and the corresponding charges.

We focused on three questions:

1. Are the physician and FSED really charging this much for emergency care?
2. Is this a medical coding/billing/charge error?
3. Are the physician’s and FSED’s charges egregious for the care provided and billed compared to their peers?

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Aurora, Colorado

Hospital Bill $50,060.92

A four-day hospital stay for the treatment of acute respiratory failure and acute bronchiolitis due to respiratory syncytial virus (RSV).

To establish savings information, ClaimDOC analyzes commercial contract pricing from data disclosed by hospitals and health plans. The audit team performs line-by-line claim audits to help clients and members maximize their savings.

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