Data Elements for Emergency Department Systems - Release 1.0 (Centers for Disease Control and Prevention, 1997, 274 p.): SECTION 3 - ED PAYMENT DATA: 3.16 TOTAL ED PROFESSIONAL FEES

Data Elements for Emergency Department Systems - Release 1.0 (Centers for Disease Control and Prevention, 1997, 274 p.)

SECTION 3 - ED PAYMENT DATA

		3.01 INSURANCE COVERAGE OR OTHER EXPECTED SOURCE OF PAYMENT
		3.02 INSURANCE COMPANY
		3.03 INSURANCE COMPANY ADDRESS
		3.04 INSURANCE PLAN TYPE
		3.05 INSURANCE POLICY ID
		3.06 ED PAYMENT AUTHORIZATION REQUIREMENT
		3.08 DATE/TIME OF ED PAYMENT AUTHORIZATION ATTEMPT
		3.09 ED PAYMENT AUTHORIZATION DECISION
		3.10 DATE/TIME OF ED PAYMENT AUTHORIZATION DECISION
		3.11 ENTITY CONTACTED TO AUTHORIZE ED PAYMENT
		3.12 ED PAYMENT AUTHORIZATION CODE
		3.13 PERSON CONTACTED TO AUTHORIZE ED PAYMENT
		3.14 TELEPHONE NUMBER OF ENTITY OR PERSON CONTACTED TO AUTHORIZE ED PAYMENT
		3.15 TOTAL ED FACILITY CHARGES
		3.16 TOTAL ED PROFESSIONAL FEES

3.16 TOTAL ED PROFESSIONAL FEES

Definition

Total professional fees billed for this ED visit.

Uses

Data on total professional fees are used for reimbursement purposes and for health care financing research. Bills submitted to ED patients who are hospitalized do not always specify the ED portion of the charges. Maintaining a specific record of charges incurred during the ED visit allows facilities to track these charges separately.

Discussion

This data element includes fees charged by the attending emergency physician, advanced practice nurse (e.g., clinical nurse specialist, nurse practitioner), physician assistant, radiologist, pathologist, and ED consultant. It excludes charges for facility overhead, nursing care, medications, supplies, and the facility portion of diagnostic tests. ED patient records usually do not include data on charges.

However, in many ED settings, information on charges can be obtained from billing records.

Data Type (and Field Length)

MO - money (12).

Repetition

No.

Field Values

Enter the total professional fees to the nearest dollar amount.

Component 1 is the monetary amount.
Component 2 is the currency type.

Example:

Component 1 = 200
Component 2 = USD

Data Standards or Guidelines

None.

Other References

1984 Revision of the Uniform Hospital Discharge Data Set (Health Information Policy Council, 1985), Report on the Uniform Ambulatory Care Data Set (National Committee on Vital and Health Statistics, 1990), Uniform Bill-92 (National Uniform Billing Committee, 1996), Carriers Manual, L 2010, Health Insurance Claim Form HCFA 1500 (Health Care Financing Administration, 1996), and Core Health Data Elements (National Committee on Vital and Health Statistics, 1996).