To be able to run an ambulance billing service is very tough. The updated healthcare Medicare rules and regulations are often tough to follow. Moreover, the recent fraud claims by many of the ambulance services in various states have caught many ambulance billing services on the wrong foot. Revamping and strict monitoring has now become part of the ambulance billing services practice. But how can one set up certain best practices that can be “naturally” imbibed into the system and ambulance crew, so that the billing can be done efficiently and fraud avoided? Well here are some of the best practices gathered from across the ambulance billing services.
1. Patient Care report (PCR): This is the most critical of all documentation. Without this ambulance billers and coders would find it hard to create the appropriate bill. Right from the call received (whether BSL or ASL), to the documentation of the patient’s condition, and verifying all patient’s details are very critical to the Billing department. Misspelling of the patient’s name can cause major time loss or even claim denials. The introduction of paperless ePCR systems makes Accounts Receivable (A/R) a much more efficient and effective process
2. Compliance: With the stringent HIPAA rules about privacy and security of patient’s information, many a time information is omitted. This needs to be very strongly followed that all rules and regulations are updated to the ambulance crew. If billing is outsourced then the outsourced vendors should see to it that all sessions are held regularly for the ambulance crew to refresh and update them about the rules and regulations and compliances are met with. All billing claims should meet Medicare requirements, especially for transportation, where the most frauds, with respect to “origin & destination” have occurred.
Having a Compliance Officer as part of the team is essential for overseeing the communications personnel (i.e., call intake, dispatch) process, especially with Medicare repetitive patient transports is being conducted as per Medicare rules & meets the CMS definition of medical necessity. Appointing an individual with a clinical background – a registered nurse/ paramedic to conduct a pre-transport on-site evaluation of the patient (for repetitive patients) where they reside and followed by a detailed evaluation, should be part of the best practices initiated in the EMS billing team.
To help mitigate risks and enhance the organization’s performance, having an effective compliance process in place is very crucial to the ambulance billing service.
3. Auditing: Make sure that internal as well as independent auditing of all documentation is done regularly. For example, the subjective narrative of the Patient Care Report (PCR) should represent the scenario that should clearly determine the “medical necessity” of the patient to assist the billing department. Patient’s signatures on forms, Physician’s Certification Statements, and all other compliances required in documentation should be audited on a regular basis. Spending time each week using a random survey to pull up documentation and reviews will go a long way in also making efficient your Revenue Cycle Management (RCM) process.
4. Recognition: Even if your processes and software and hardware are all in place and updated, yet it is the people – the ambulance crew that helps drive the efficiency of any process to make it more efficient. The one way to motivate the ambulance crew is to initiate recognition programs into your services. This way, not only will the motivated crew help give their best but will also help prevent fraud. The “Best Documentation”, the “Biller with the least denial claims”, “Best coder”, “Best Knowledge worker” etc. awards or certifications is one way to ensure that your documentation is on par with the rules and regulations and motivate your crew to give its best so that your Billers or Billing Service, gives you the optimum performance desired.
To sum up, checks should be ensured and best practices initiated especially in these areas of billing:
- Billing for Origin & Destination
- Billing for Mileage
- Billing for “Medically Necessity”
- Billing “Upcoding/Downcoding”
- Misuse of Beneficiaries numbers and Kickbacks
Thus, with proper checks & processes and following good “best practices”, the desired outcome can be delivered which can result in the prevention of ambulance fraud.