10 Tips to Help Reimbursement and End Patient Complaints in Ambulance Billing

June 09, 2016

ambulance tips

With the number of fraud cases on the rise, especially in the Ambulance service, and vigilance stepping up, many ambulance services are seeing a decrease in their revenues. This is often because ambulance staff overcharges patients as they feel pressured by the costs and strained by low Medicare and Medicaid rates and leads to litigation. This kind of situation can be easily avoided if the below tips are followed:

  1. Trained Staff: If your staff is well trained then paying heed to what was reported under the 911 call and what was written in the Patient Care Report or first report, will help the medical billers associated with the ambulance service to know what to bill for and not miss any reimbursement that could lead to wrong billing.
  2. Documentation: This is the most crucial aspect of any medical billing and coding service. The documentation is the most singular crux of getting it right. The results of that assessment when documenting for the Patient Care Report not only dictates treatment but also contributes to the bulk of what goes into the report to help the billers and coders bill rightly to bring in revenue.
  3. Transport: Medicare and Medicaid programs pay for transportation and most insurance payers follow suit. It is very important to stress on your staff the necessity to record the origin and destination locations, or where the patient was picked-up and dropped off. Additionally, the number of miles traveled when transporting the patient from Point A to Point B needs to be recorded well. Misuse of this can lead to fraud and abuse of the system and your staff needs to be reminded of this constantly.
  4. Days to Bill: Keep your days to billing shorter. If you can invest in an electronic patient care reporting system then billing can be done in a day, given your documentation is seamless and clear to the medical billers and coders.
  5. Recheck on private insurance payments: Acceptance of the payment by the insurance company, especially the private insurers should always be rechecked. If you have outsourced the coding and billing to a reputable company with a staff that has expertise and is knowledgeable in ambulance billing, then you will never have to face angry patients or even reduced reimbursements, as they will be focused on seeing that the correct amounts are duly paid, be it the insurance company, the patient, or Medicare and Medicaid.
  6. Denial & Follow-up process: Having a well trained filed ambulance staff and a coding and billing team is very essential to avoid denials and follow-ups. Not just improper coding but also improper documentation with respect to person’s name and details is very essential. Here an efficient process of verification needs to be integrated between the field first reporting personnel and the coders and billers.
  7. Accounts Receivable and Collection percentage: For enhanced and effective Revenue Cycle Management (RCM) process, the cash collection percentage of patients (CPT) over time should show an increase. This is measured by the total dollars collected in a period divided by the total transports for the same period. If that number is not more than Medicare allowable, then you are not effectively maximizing insurance revenue. If the average cash collection per patient shows an increase, then you are doing just fine. Tying this up with the Accounts Receivable (A/R) report, is s sure way to identify the health of your Revenue Cycle Management process
  8. Prioritize: To avoid patient disappointment and litigation, especially when patients ask billing questions, the best way is to get your field ambulance staff either trained or co-ordinate with the billing department, in-house or outsourced. The priority of your field staff is to deal with the care of the patient and be focused on what they have been trained to deal with. For a seamless process, it is best to either let the field staff guide the patient or their relatives to the billing office, rather than even try to attempt to answer queries they may not be well equipped.
  9. Keeping Updated with Medicare fee schedule and healthcare reforms: With the changing healthcare reforms and annual change in Medicare fee schedule and how this translates into increasing ambulance service revenues is very crucial. Understanding what each change in base rate and mileage will translate to especially in terms of cash collections and the rates of other ambulance service providers, is very essential to staying competitive in the market and also creating an effective Revenue Cycle Management process.
  10. Compliance: This is the most essential and crucial to all ambulance service providers- staying compliant with state and federal rules and regulations. Being compliant is very crucial to avoid litigation and also avoid fraud and abuse of the ambulance services that your ambulance field staff could “erroneously” get involved in either with patient transportation or bad reporting.

Ensuring Ambulance transport services are appropriately reimbursed and patients are well tended to and on time, is vital for the success.


Category : Best Billing and Coding Practices