April 15, 2016
The Accountable Care Act (ACA) or popularly known as Obamacare has a two- fold goal: lower healthcare costs and improve the health of the American population. Both, if seen from a larger picture, are beneficial to healthcare providers, given that the Act has also now made eligible those who were not insured earlier. However, due to the numerous frauds that have happened over the years especially when it was observed that Medicare costs had gone up, tighter rules and regulations are now being put in place.
Medicare paid more than $50 million in potentially improper bills from ambulance companies for rides for older Americans, of which, the payments included $30 million worth of ambulance rides over a six-month period despite an absence of evidence, based on Medicare records; and another $24 million in payments for rides to and from doctors’ offices and other destinations for which Medicare does not cover ambulance services. Investigators found that Medicare’s spending on ambulance services doubled to $5.8 billion between 2003 and 2012.
With the red lights flashing on waste and abuse and fraud, and not wanting to be hauled in for fraud, many ambulance services try to revamp their entire staff, and start employing people who are certified and knowledgeable. But you could waste a lot of time and effort during this process and the focus on your core competency of running a clean service can take a hit, affecting your revenues. Your next best bet is to search for an Ambulance billing vendor.
But how do you know who is the best among them?
While the provider can focus on improving your revenues with better operational efficiency, you can spend your time improving your business with quality care for the patients. There are many things to ask to make sure you have the best ambulance billing provider.
The Billing provider has to be aware of the Health Insurance Portability and Accountability Act (HIPAA). Make sure that they are in compliance, and question how they can protect the privacy of a person's health information, which is a mandatory compliance.
Documentation & Training:
How well prepared and trained are they with the recent ICD-10 coding system. Will they provide training to your internal staff when it comes to documentation and working with "run sheets" that are known to collect the first incidence observations. Any wrongly written descriptions in the sheet could lead to wrong codes and hence claim denials which now require good documentation support when appealing. They need to provide updates with new rules & regulations that CMS initiates from time to time.
This is very crucial for your budgeting and your Revenue Cycle Management process. All costs and payment structure should be well formulated. All costs, start-up costs, appeals costing, etc should all be well documented on the contract. If they show the kind of well documented costs, and what exactly you owe them for the different services they will render you, then you can plan your budget accordingly. Also their policies on documentation and claim processing should be highly detailed and include the kind of trained and certified staff present to handle certain emergency services which require quick and speedy interactions.
Can they increase your revenue? :
Since you wish to focus on the core competency, but also need your profits to increase simultaneously, you need to be very upfront when asking them how they have increased profits for most other ambulance services when billing for them. Although they may not necessarily spill their 'secret strategy" but an overall picture of how they manage the processes and workflow and claim appeals, will give you a general idea of how profitable they are for you.
Trends and Technology updating:
Today's technology crafted world, which has even crept into the medical billing and coding industry, has helped many healthcare providers to revamp not just their technology but also the workflows and processes to bring about a change in the Revenue Cycle Management (RCM) process and thereby operational efficiency, and reduce operation & administrative costs in the long run. Ensure that the ambulance billing provider you plan to work with is current with not just technology updates but also the rules and regulations with the electronic billing services.
So once you are assured that the above points meet your expectations, assess what you need and how they can meet those needs, you are set to go with the best ambulance medical billing company.
Best Billing and Coding Practices