May 31, 2016
A silent killer of the ambulance business today is revenue cycle mismanagement. This occurs due to ambulance companies focusing on patients to save lives, and as they get too busy in handling this aspect, the revenue process of collections becomes an after-thought.
In the ambulance business, reimbursements are decreasing from insurances (private and public), business costs of medical care are growing, and with increased federal government involvement, compensations are getting affected. Further, the healthcare industry is inundated by monetary limitations, and by the Affordable Care Act. Revenues are dwindling as ambulance services do not adhere to fee and time schedules, and payers’ guidelines that are constantly changing. Hence, it is often cited that ambulance companies must begin looking at their revenue cycle management and tackle the issues. They need to adopt new tools and technologies, train their manpower, and submit claims on time to reduce errors and enhance collections.
Revenue Cycle Management- It is important to ensure that ambulance services possess a RCM team which can take on the responsibilities for accurate and timely collections. They should also be able to create customized reports which should include the financial metrics of the organization. Customer updation along with fee schedules should be the responsibility of the team aiding in augmentation of workflow.
The claims management team must be proactive with the payer team and check on the reimbursement changes. There should be no delay in Accounts Receivables (A/Rs), and these must be reduced on a continued basis along with an increase in accurate and timely compensation.
Compliant billing- Many times outsourcing is a better option than in-house billing. The outsourcing team is well trained with the nuances of ambulance billing and usually leaves no room for mistakes. They manage to obtain the maximum reimbursement possible from the insurance payers. They also help in avoiding overbilling along with correct reporting in comparison to expenses and payments. Due to compliant billing, overpayment is also mitigated.
According to www.sharpab.com, "That last 10 to 15% of the revenue in ambulance billing takes as much work as the first 85 to 90%." The factors contributing to this are usually denied claims, incorrect patient IDs on claims, missing or incorrect information, claims with improper insurance etc. Such claims have probably not been reworked upon due to the system not being able to identify them. It is imperative to keep a check on flagged claims which have been termed as in-collectibles and recheck with insurances for payments. Automation processes such as electronic payment EOBs can aid in identifying erroneous claims.
Focus on unpaid bills- Ambulance companies also need to concentrate on unpaid bills which helps them break-even in their operations. They need to keep a tab on the security requirements and other regulatory impediments for optimum healthcare. Incorrect data entry or coding inaccuracies can make the business lose thousands of dollars.
The accounting team needs to track every dollar and ensure that the collection rates are pertinent. Best practices and reviewing of procedures must be followed in the billing and coding arena.
Best Billing and Coding Practices