Recently, ProPublica published a news story suggesting USA Emergency Centers, licensed to operate four Physicians PremiER emergency rooms, dramatically overcharged for a COVID-19 test. We want to assure our patients, staff, physicians, other Physicians PremiER sites, colleagues in healthcare, and our communities that we are committed to best practices and high integrity.
To clarify the issues portrayed in the article, USA Emergency Centers, along with all emergency rooms in America, are required by the U.S. Emergency Medical Treatment and Active Labor Act (EMTALA) to provide a medical screening exam (MSE) on patients to determine if an emergency medical condition exists. If a condition is determined to exist, we are also required to treat and stabilize the patient. The MSE, treatment, and stabilization are provided regardless of a patient’s financial ability to pay. When a patient has insurance, USA Emergency Centers is legally required to bill the visit as an emergency room visit and insurance companies are required to pay, at a minimum, the in-network rate.
USA Emergency Centers’ healthcare providers have and will continue to issue COVID-19 tests as part of emergency room diagnostic processes based on best practice clinical protocols. Throughout the COVID-19 pandemic, USA Emergency Centers has leveraged a variety of COVID-19 tests to best serve its patients, including rapid in-house PCR testing and antigen testing.
Based on our existing internal review processes, we found a coding error as the source of the charges related to the specific test featured in the ProPublica article. USA Emergency Centers had identified and corrected this error prior to the date of publication. We are also comprehensively reviewing all COVID-19 claims to ensure the coding is correct and will reprocess any improperly coded claims to reimburse the applicable insurance companies as part of our ongoing processes. There are many practices in place to support the rectification of errors within medical billing, including internal audits and regular insurance company and healthcare provider reviews.
Healthcare billing is complex, and errors do occur. Rapidly emerging situations like COVID-19 are particularly difficult as new diagnostic tests, treatments, billing codes, and standards for patient care change frequently as physicians, scientists, and regulators learn how best to care and respond to patients and the community at large.
While this article, and its characterization, have been disheartening to our staff who have served tirelessly on the frontlines risking their health to treat more than 10,000 patients since the pandemic began, we remain dedicated to providing excellence in emergency healthcare to our patients. We will continue to advance our processes to serve as a responsible partner to our communities and insurance providers.
Jay Holtz, CFO, USA Emergency Centers Management, LLC