Ambulance Billing Services like any other medical billing specialty just requires some very basic focus on the right things to ensure that payments are made on timely manner. It is easy but critical that no bill which has a chance of being paid somehow goes unpaid. Whether you do Ambulance Billing and EMS Billing in - house, or use the services of offshore an Ambulance Billing Service, the basics of the work do not change.

Difference Between EMS Billing And Private Ambulance Billing

  • EMS Departments Are Usually Required To Provide Service Whether They Will Be Paid Or Not
  • In Ambulance Billing The Payer Controls What Has To Be Done In Order For Them To Pay
  • Government Programs That Simply Pay Untimely – And You Still Have To Do Business With Them
  • Multiple Payers Paying Parts Of The Same Bill
  • Fixed Amounts To Be Paid And Fixed Amounts To Accept As Write Offs

Must Know Things For Profit

Support The Medical Necessity With Documentation

By definition, medical necessity proves why transportation by any other means is needed for the patient. In order for insurers to pay, medical necessity must be proven within the documentation and should include the primary impression, chief complaint, and all corresponding treatment to the patient.

Do keep in mind that Centers for Medicare and Medicaid Services (CMS) has stated that the diagnosis of a disease or illness may not be enough without corroborating evidence / statements to support medical necessity for ambulance transport.

Be Specific

Include in your patient care report a detailed assessment on every transport as well as the findings of your assessment. Include Glascow coma scale, skin conditions, mental status, pain level, etc. Be very specific in documenting all the signs and symptoms of the patient’s chief complaint.

Don’t Imagine Be Truthful

Make sure your documentation is truthful. It is not in your best interest to develop a list of terms or symptoms to use to get the transport paid. Your patient care report is a medical legal document. Using false statements in your report to support medical necessity can result in a prosecution in the court of law.

Always Document Treatment Outcomes

Remember to note all treatments in your narrative. Explain the situation, symptoms, actions taken, and the effects of treatment. If a medication is administered to the patient, include in your report whether there was a positive, negative, or no reaction.

Basic Steps That Must Be Completed For Full Reimbursement

  • Get All Information Needed To Code And Bill – Insurance, EPCR Report, Patient Information
  • Verify That The Bill Was Accepted By Payer Immediately And / Or Received By Patient.
  • Process And Re - File Any Of The Immediate Rejects And Verify All Claims Sent Were Received Or Rejected And Refilled Immediately
  • Get Insurance And / Or Process Eligibility Checks, And / Or Use Insurance Gathering Techniques
  • Get That First Bill To Insurance And/Or Customer Out The Door Immediately.
  • Post Cash And Review Any Denials And Rework / Appeal And / Or Move To Next Payers

Run Daily – Weekly – Monthly Audit Reports Of Unpaid Bills

Review all follow ups the day they occur and re - bill if needed.  Ensure you have reports that find all claims in “limbo” and resolve the reason they are stuck.  No Bill should ever be stuck for any unknown reason.  At some point it is patient pay – or collections or written off as non - collectable. 

Claims sitting pile up and then payable claims in lost in the blank hole of claims unknown – if it is not getting paid ever flag it and remove from your active work list.

Published By - Medical Billers and Coders
Published Date - Jun-21-2018 Back

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