Billing for ambulance services through Medicare is a very specific and closely watched part of managing healthcare revenue cycles. When charging for EMS and ambulance services, you have to take into account particular transport parameters, loaded miles, and severe medical necessity standards. This is different from regular medical billing. For EMS agencies, even one mistake in a Patient Care Report (PCR) can cause payments to be late, claims to be denied, or even expensive Medicare audits.
To keep your business healthy and in line with the law, it’s important to know where the largest risks are and how to put together a team that can handle them.
The Problem with Documentation
Many agencies think that coding is the hardest part of charging Medicare for ambulance services. It’s very important to use the right HCPCS codes and modifiers, but the truth is that most agencies fail when it comes to the narrative documentation that backs up the claim.
Medicare needs clear confirmation of “medical necessity,” which means that the patient’s condition had to be such that moving them in any other way would have put their health at risk. Everyone who works in the billing process needs to go through a lot of training to get this right. In reality, making sure that all the paperwork is in order is a huge job for both the frontline medics and the non-clinicians who work in your billing and quality assurance departments. Your organization is at a greater risk for compliance problems if your dispatchers, billers, and coders don’t know the details of what makes a transport medically required.
Using Clinical Knowledge in Billing
To fix problems with paperwork and make the Medicare billing process easier, several effective EMS companies are connecting clinical care with revenue cycle management.
One very efficient way to do this is to include clinical expertise directly in your billing and Quality Assurance (QA) processes. For example, using a Remote U.S. RN to look over complicated claims, check PCRs, and provide field teams comments on their paperwork can cut down on mistakes by a lot. A nurse knows what’s going on with the patient and can immediately tell when a story doesn’t have the right information for Medicare to authorize a claim. This added level of professional scrutiny helps keep claims from being denied before they ever get to the Medicare system.
Having the right staff makes all the difference.
To get the most money back from Medicare for your ambulance service, you need more than just new billing software. You also need to make sure you have the appropriate personnel in the right places. A financially healthy EMS service needs competent administrative personnel, from detail-oriented billers to clinical QA professionals.
It shouldn’t be a constant pain to handle your EMS billing. The key to being compliant, lowering the risk of audits, and keeping your business financially healthy is having the correct team in place.
Are you ready to make your healthcare company a stronger, more productive place to work? Find out how StaffDash can help you find the best clinical and non-clinical personnel now.