Emergency Room Trending Report

The Arkansas Medicaid program encourages the establishment of a Medicaid Medical “home” within the PCP’s office. Frequently emergencies, however, must be treated within the emergency department of the nearest hospital. Sometimes it is unclear to the recipient if the care is urgent or not. In many of these cases, the hospital will assess the situation and refer the recipient back to his or her PCP for all treatment. Also there are those occasions when care is not urgent but the PCP is unable to treat his or her patients due to certain circumstances such as time of day or being away from the office. Recipients can also be out of town and unable to reach the PCP’s office. For these reasons, PCP’s sometime refer recipients to the emergency room for non-emergent care.

Whenever care is provided in the emergency department there is a claim billed by the facility and by the physician. These claims may be billed as emergent, non-emergent or assessment. Medicaid uses the ER Trend Report to track how often the physician and facility billing components are consistent and match billing categories.

ER Trend Report

We create and disseminate the ER Trend report quarterly to all Hospitals who actively bill ER services during the period. The report provides the following information:

• Billing comparison between hospitals and physicians for a specific recipient and data of service.
• Cost and utilization trends
• A letter from the AFMC corporate medical director highlighting significant issues or trends in the data
• Findings of a special studies comparing ER billing by facility, physicians and geographically.

A sample ER Trend Report can be viewed by clicking here.

What providers can do:

• Review data in the report to determine how their ER billing compares to the statewide average and to physicians billing for the same recipient and date of service
• Request detail reports to review specific information on each paid ER claim summarized on the trend report
• Request visits from the MMCS provider relations staff if there are additional questions

ER Trend Sample Report

View PDF of ER Trend Report (155K)

Request visits from the MMCS provider relations staff if there are further questions about the data in the report or ways to achieve higher efficiency.