Houston, 2017.
Hurricane Harvey had turned the streets into rivers. Inside a community clinic, patients lay on cots, IVs dangled from broom closets, and nurses were scribbling vitals on sticky notes.
And when it came time to bill?
“Totally collapsed,” the clinic director told me.
“We didn’t know who we treated, what we coded, or if we’d get paid at all.”
Welcome to the real world of medical billing during disasters.
It’s messy. It’s fast. It’s broken. And most of us are not prepared.
⚠️ Why This Matters Right Now
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Record-breaking floods are hitting the Midwest
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Wildfires already scorching the West Coast
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HHS just extended the Public Health Emergency (PHE) for disaster relief zones
If you're a clinic, hospital, or mobile unit in these regions, your billing systems are at risk.
🔑 Highlighted Keywords: disaster medicine, CMS emergency waivers, EHR failures, medical billing, crisis healthcare
💡 5 Hard Lessons on Billing in a Crisis (You Won’t Learn in Training)
✅ 1. Forget Perfect. Go for Minimum Viable Documentation.
During chaos, you don’t need an epic note.
You need who, what, when, and why — fast.
🧰 Use:
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Paper + pen
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Phone photos
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HIPAA-secure voice notes
🗣️ Dr. Carla Nguyen, Emergency Physician & Disaster Lead:
“In Haiti, laminated SOAP notes and dry-erase markers saved our documentation process. You just need something that works.”
✅ 2. Know the Rules — Before You Need Them
CMS doesn’t make emergency billing obvious. But waivers exist:
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Skip prior authorization
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Use alternative care sites
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Get faster reimbursements
Print them now. Put them in your clinic’s emergency folder.
🗣️ Angela Martinez, Health Policy Analyst, GlobalMed Law Group:
“Clinics leave money on the table because they don’t file under waiver conditions. Know your rights before the storm hits.”
✅ 3. Your EHR Will Fail. Plan for It.
Servers crash. Power dies. Logins don’t load.
🔌 You need:
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Offline templates
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Paper superbills
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Staff trained in “analog” mode
🗣️ Jason Bell, former VA Health IT Director:
“Every hospital thinks their cloud-based EHR makes them disaster-proof. They’re wrong. If your internet’s gone, you’re flying blind.”
✅ 4. Assign a “Billing Catcher” Per Shift
One person. One job:
✔️ Double-checks documentation
✔️ Flags missed patients
✔️ Captures services provided
Call it your billing triage nurse.
✅ 5. Practice Like It’s Real. Before It Is.
Run mock drills. Roleplay emergencies. Turn it into a game.
The winner? The team that bills and saves lives.
🧨 What I Screwed Up So You Don’t Have To
I helped with a mobile clinic post-flood. For 3 days, we didn’t chart a thing.
We were too focused on care. And yeah, we cared deeply.
But weeks later, patients got hit with surprise bills.
We lost tens of thousands in claims.
Care without billing = chaos.
Billing is part of the rescue — not a burden.
❓FAQ: Your Billing-in-Crisis Cheat Sheet
Q: Can we bill later if we miss real-time notes?
A: Sort of. But it’s a disaster. Document something now and clean it up later.
Q: Any special billing codes for disaster care?
A: Use standard CPT/ICD codes with modifiers like CR or DR. Check CMS updates.
Q: Can we balance bill during emergencies?
A: No. The No Surprises Act prohibits it for out-of-network emergency care.
Q: What should go in our disaster billing kit?
A: Paper forms, CMS waiver printouts, backup chargers, a USB scanner, offline templates.
Q: Are we legally covered for field care?
A: Mostly. The PREP Act + state declarations offer some immunity. But billing errors? Still your problem.
📰 This Week's Must-Read References
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CMS Waiver Update — May 2025
“CMS releases updated emergency billing waivers for disaster-affected counties.”
👉 Read the CMS Bulletin and read more here. -
Wildfire-Driven Clinic Displacement in California
“Dozens of mobile clinics operate without EHR support amid power outages.”
👉 Explore the research on Direct Relief and California’s DHCS response. -
EHR Failures Surge After Storms, Study Finds
“45% of rural hospitals report EHR access issues during disasters.”
👉 Learn more from the National Rural Health Association and read the latest study from Health Affairs.
📣 Call to Action: Get Involved
You’ve seen the chaos. You’ve heard the stories.
Now it’s time to raise your hand.
✅ Start learning — run a mock disaster billing drill
✅ Engage with the community — share your disaster prep checklist
✅ Take action today — download our Disaster Billing Toolkit
✅ Be a thought leader — speak up about medical billing resilience
✅ Contribute your ideas — what’s your billing-in-chaos story?
#DisasterMedicine #MedicalBilling #CrisisCare #CMSWaivers #EmergencyPreparedness #EHRResilience #HealthcareHeroes #StartLearning #FuelYourGrowth #BeTheChange
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