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Ambulance Billing Guide for 2019

All cities throughout the New England area are faced with the need to conserve on expenditures and to provide the most value for services which have been budgeted, and ambulance service is no exception. Since ambulance service is so critical to the community and those individuals in need of emergency transportation to the hospital, ambulance billing is an area that must be carefully considered and budgeted for 2019 and beyond. With that in mind, the following guide is offered, so that the various municipalities of the New England area may properly plan for accurate ambulance billing in the coming year.

Annual Inflation Factor (AIF)

Section 1834 of the Social Security Act states that each year the fee schedule for ambulance billing must be increased so as to include the cost of inflation, and this figure is referred to as the Annual Inflation Factor. This factor is arrived at by calculating the consumer price index for all urban residents for the preceding year, ending in June.

For the year 2019, the AIF has been calculated to be approximately 2.4%, which means that all ambulance fees for 2018 would automatically undergo an increase of 2.4% for 2019. While this may not be the only factor which is applied to ambulance pricing in New England, it is the base entitlement for pricing, according to the federal government. Any local considerations would have to be added in to this figure, in order to arrive at the appropriate billing figure for a given area.

Ambulance billing services provided by New England Medical Billing

With a better than 95% collection rate, New England Medical Billing ranks very highly in yielding a high return on investment for services provided.  With highly trained and knowledgeable staff members, collections are done efficiently and promptly, while personal injury protection benefits are still available. A partial listing of the services provided by NEMB for 2019 will include all the following:

  • Coding Services – Our staff has a number of certified coders , so that accurate and timely billing can be carried out, with minimum chance for costly denials.
  • Documentation reviews – NEMB specialists conduct  reviews of documentation and offer critical feedback to providers. When documentation is inadequate, this is pointed out so it can be rectified.
  • Detailed Analysis and Reporting – Clients of New England Medical Billing have access to a whole range of reports to obtain critical information. There are financial reports, weekly deposit reports, cost projection reports, payments by payer, and fee schedule analyses, among others. All of these reports can be fully customized to accommodate clients’ needs for use as management tools. In addition to prepared reports, our expansive database can be accessed to prepare ad-hoc reports which will help any municipality improve on its business practices.
  • Ongoing support – Every community requires a fully functional and prompt ambulance service, as well as the billing support which makes all those services a reality.  NEMB prides itself on making available to clients all the advice and support needed to answer all questions, and to develop an effective billing strategy founded on outstanding communication.
  • Accounts Receivable Management – Clients’ accounts can be reconciled monthly, and all files and documentation are maintained by NEMB so as to stay in compliance with any municipal requirements regarding the subject. Data is backed up regularly, so that there will be no catastrophic loss of information should an accident occur. All accounts receivable information is managed and maintained in a highly efficient manner by our trained specialists.
  • Confirmation of Patient Eligibility – Before any medical billing is executed, NEMB ensures that patients are eligible, especially in the area of auto accident claims. Because paramedics are more concerned with life-threatening services than with capturing all the relevant motor vehicle insurance data, we go the extra mile to verify all that. Our personnel will contact the appropriate Police Department or Fire Department to obtain accurate information before any billing is carried out. Everything which is necessary to ensure a clean claim on the first attempt is addressed by our specialists, so that billing can be done smoothly and efficiently, with minimal denials.
  • Front-end training – All of our clients have access to coding and documentation information, so that critical personnel can be informed about appropriate procedures and codes, which they can then use in the performance of their daily jobs.
  • Preparation of Abatement Lists – Our trained specialists are well-versed in the preparation of Abatement Lists, and can document all the processes associated with the ongoing compilation of these lists. That includes verifying, retaining, and providing advice on the entire documentation process.
Ambulance Billing Guide for 20192019-01-10T16:28:37+00:00

Which School Health Services are Covered by State Medicaid?

Children who are covered by Medicaid receive affordable and comprehensive health care coverage, to allow them to continue academic pursuits and become successful as adults. More than 30 million young people are currently receiving benefits under this program, and research has demonstrated clearly that this assistance makes a big impact on their future, as well as helping them deal with current medical conditions.

Services covered by state Medicaid

Probably the single most important area of coverage for eligible children is providing the medical services needed by children with disabilities, so they can receive a good education. The goal of these services is to allow disabled children to be educated in the least restrictive environment possible, given their specific disabilities. However, this is far from the only area of coverage supported by Medicaid. All children who are eligible can receive such health services as dental and vision screenings, to ensure that basic health needs are being attended to.

Some of the other specific services which participating schools can be reimbursed for under state plans for Medicaid are the following:

  • Nursing services
  • Mental health services
  • Audiology services
  • Physical therapy
  • Speech therapy
  • Nutritional assessments and counseling
  • Transportation
  • Facilitating of determination for Medicaid eligibility
  • Coordinating and monitoring Medicaid services
  • Providing transportation to Medicaid-covered activities
  • Making referrals
  • Medical service program planning
  • Positive effects of Medicaid coverage

    A significant amount of study and research have gone into determining the impact of Medicaid on students who receive coverage while in school. Quite naturally, the government agencies who contribute the funding for state Medicaid are anxious to know that the funding is having a positive impact, and is accomplishing what the program is intended to do. Statistics compiled on this subject are uniformly positive about the huge impact Medicaid coverage has on students in school and long afterward, when they reach adulthood.

    Research has shown that children covered by Medicaid in school retain better health as adults, with fewer trips to the hospital and fewer visits to the emergency room. Medicaid-eligible children have also shown that they are more likely to graduate from high school or college, earn bigger salaries, and pay more taxes than students who receive no Medicaid coverage due to ineligibility.

    It is also reported that virtually all school districts benefit from the funding they receive for Medicaid-covered services because those funds can be applied to health services administered to all students enrolled, not just those receiving Medicaid services. In a survey recently conducted, almost half of all school superintendents indicated that they used Medicaid reimbursement funds to pay for general school supplies and health services, which all students benefit from. These general health care services include such critical areas as monitoring and caring for children with asthma or diabetes, as well as providing limited dental care.

    One last service provided by many schools in this country is to serve as a kind of gateway for children in low-income families, by helping to get them enrolled in Medicaid and the Children’s Health Insurance Program (CHIP). The importance of Medicaid funding for schools would be hard to overestimate, given the fact that even for services which are not covered under Medicaid, the funding allows schools to reach out and connect children with services needed outside of school, and outside the Medicaid program itself.
Which School Health Services are Covered by State Medicaid?2018-12-20T15:43:44+00:00

Top 5 Urgent Care Billing Tips

Because of the number of steps involved in the claims creation process, it’s very common for there to be some mishaps in urgent care billing. For that reason, it becomes very easy for clinics and health facilities to be underpaid for urgent care services. To avoid this possibility, consider the five most important urgent care billing tips identified below.

Establish your contracts

If your clinic does not have its contracts properly established with the local payers for medical services, you have little hope of being paid on time or in the proper amounts. You should have all these contracts in place before you even open your clinic ideally, so that you’re not negotiating while waiting to be paid for claims. If you are obliged to negotiate contracts, you won’t be able to accept patients’ insurance coverage, and that means you’ll only be able to operate on a cash-only basis – which means you’ll have very few patients.

Use good front-desk practices

Front-desk personnel should be trained to check the current insurance for every patient, rather than asking if anything has changed since their last visit. This can help eliminate some improperly filed claims, for instance those with inaccurate demographics, addresses, or insurance numbers. When anything is submitted to a payer which is not accurate, it can result in having to re-submit, or having the claim denied altogether because it was sent to the wrong payer. It’s also a good idea to have your front-desk personnel audit denied claims periodically, to see if there are any trends associated with those denials.

Don’t overlook valuable charges

In the day-to-day hectic pace of a medical facility, it can be very easy to overlook some valuable charges, and therefore miss out on an entitled payment. Some of the most common oversights are injections, X-rays, blood draws, lab work, and reading of results. The volume of drugs dispensed is another area of fairly common oversight, and thus underpayment. Make sure your staff has been trained to identify and include these frequently missed charges, so you don’t end up providing free services.

Make sure to use the right billing codes

Choosing a lower-level 2 or 3 code might seem to be just right when billing charges are being coded, but higher-level codes are often justified and should be used in those cases. Your medical practice could be losing a significant amount of money daily by underestimating the code levels on charges. In addition, the American Medical Association regularly updates codes, and there have recently been thousands of new codes added to the compendium of charges. Make sure your office personnel are aware of these new codes, and that the correct ones are used during billing.

Use the correct code modifiers

Code modifiers help to identify the service which was delivered to a patient, and they provide additional information beyond the base code on any given charge. Although code modifiers are often essential for identifying just what kind of service was administered, these modifiers are often overlooked entirely or misused, thereby conveying an inaccurate picture of the service which was delivered. Make sure your staff are well-versed in using these code modifiers, and that they have a good understanding of which code modifiers are accepted by all payers.

Top 5 Urgent Care Billing Tips2019-01-02T17:52:43+00:00

Demographic information critical for ambulance billing success

Even in an ideal scenario, it’s difficult to capture complete and accurate demographic information. There are typos and misspellings with which one must contend, and patients don’t always provide correct data. Now consider an emergent situation in which a patient requiring ambulance transportation may not even be conscious. At times, it’s nearly impossible for paramedics and emergency medical technicians (EMT) to capture simple details such as a name or date of birth. Saving the patient’s life and rushing him or her to the closest hospital is the number one priority.

Hopefully, the patient receives the care that he or she needs in a timely manner. However, when it’s time to submit the claim for ambulance services, many municipalities discover that they don’t have enough information or the right information. Designating these claims as ‘self pay’ is not an optimal solution because the reimbursement rate is oftentimes much lower for self-pay than it is for fee-for-service. If a municipality tries to submit a claim with demographic errors and omissions directly to the insurance company, there’s a high probability that it will be denied.

 

Obtaining demographic information through collaboration

Best practice is for billing vendors working on behalf of municipalities to establish relationships with local hospitals and create information technology (IT) integration with hospital health information systems to obtain complete and accurate demographic and insurance information for billing purposes. This ensures that there are no information gaps and that patients are billed directly only as a last resort.

It takes time and effort to cultivate these relationships. However, once these relationships are established via personal and IT connections, it’s much easier for a billing vendor to obtain information necessary for claims submission. This includes the patient’s full name, date of birth, address, phone number, Social Security Number, and insurance identification number.

What must occur from an IT perspective to enable integration? Fundamentally, your billing vendor must be willing to take the time to reach out to a hospital’s patient accounting and IT departments. Consider asking these three questions of your vendor:

  • Does your billing vendor work closely with hospital IT systems to obtain accurate and complete demographic information?
  • Does your billing vendor have the ability to integrate with hospital demographic systems using HL7 or other types of interfaces?
  • Does your billing vendor have established relationships with hospitals?

 

Ensuring compliance through documentation

It’s also important for paramedics and EMTs to document the nature of the beneficiary’s medical condition at the time of transport. Medicare pays for emergency and non-emergency medical services when the beneficiary’s condition is such that other means of transportation would endanger him or her. In its FY 2017 Work Plan, the Office of Inspector General (OIG) is taking a closer look at whether Medicare payments for ambulances services were warranted.

 

Other strategies to capture demographic information

Following are three other ways in which paramedics and EMTs can obtain much-needed demographic information at the time of transport:

  1. Ask a loved one for demographic information before or during the transport itself.
  2. Obtain information from the hospital emergency department at the time of transport.
  3. Verify existing demographic when there is a repeat transport.

To learn more about our billing programs, contact Nancy Dolgin at NEMB at 508-297-2068 x232.

 

About NEMB

NEMB understands the importance of building meaningful relationships with entities and individuals within each municipality so we can ensure timely and compliant billing. Not only do we communicate regularly with fire and police departments, but we also take the time to get to know and network directly with town accountants, town managers, mayors, and others. We identify the key individuals within each municipality who can provide the critical information we need to bill ambulance services appropriately and as quickly as possible.

With nearly 20 years of experience in municipal ambulance billing, our credentialed staff members are trained in every aspect of effective municipal service billing. We specialize in auto accident claims that continue to challenge municipalities and result in significant revenue lost. We pursue auto accident claims as quickly as possible so our clients can take advantage of personal injury protection benefits before those benefits are depleted. Our expertise and focus on communication and relationship building help to maximize cash flow and ensure the fastest possible return on investment for the services provided. NEMB’s ambulance billing record has consistently yielded over a 90% collection rate.

 

Demographic information critical for ambulance billing success2019-01-02T17:52:47+00:00

CMS rule reversal for Medicaid free care: Will additional reimbursement be on the way for Massachusetts public schools?

Massachusetts public schools participating in school-based Medicaid claiming may soon see a revenue boost thanks to a CMS reversal of its long-standing Medicaid free care rule. This surprising reversal essentially allows schools to bill Medicaid-covered services for all students—even when those students don’t have a documented Individualized Education Plan (IEP).

In a letter to state Medicaid directors dated December 15, 2014, CMS formally withdrew its prior guidance on the free care policy with the goal of being able “to facilitate and improve access to quality healthcare services and improve the health of communities.”

These developments come in the wake of two other states—California and Oklahoma—successfully challenging the free care rule that had, for years, stated that schools may not use Medicaid funds to pay for covered services that are provided for free to the entire student population.

Both states successfully argued that this rule was not based on federal statute. However, many states—including Massachusetts—have continued to apply the rule due to a lack of technical guidance as well as confusion over whether schools nationwide—or only those in California and Oklahoma—could qualify for federal reimbursement.

In its 2014 letter, the agency goes on to state the following:

Under this guidance, Medicaid reimbursement is available for covered services under the approved state plan that are provided to Medicaid beneficiaries, regardless of whether there is any charge for the service to the beneficiary or the community at large. As a result, Federal Financial Participation (FFP) is available for Medicaid payments for care provided through providers that do not charge individuals for the service, as long as all other Medicaid requirements are met.

States nationwide are slowly coming on board to follow in the footsteps of California and Oklahoma. Massachusetts, for example, may announce statewide changes as soon as October. Once schools are able to expand Medicaid billing for all students, they could see a significant increase in reimbursement—particularly related to nursing services. According to pewtrusts.org, health advocates see this policy change as an opportunity to develop programs in public schools to help students understand and manage chronic conditions such as asthma, diabetes, and mental illness. In some cases, the additional reimbursement may also be able to help schools hire more nurses. According to the National Association of School Nurses, more than 30% of schools only have a part-time nurse, continuing to drive a school nursing shortage nationwide.

Medicaid-covered services include speech therapy, occupational therapy, physical therapy, audiology services, counseling, nursing services, personal care, behavioral health, and applied behavior analysis.

What can your school do now to prepare for potential changes? Consider these tips:

  1. Review all of your vendor’s services. Does your vendor have experience in school-based Medicaid claiming along with compliance for HIPAA and the Family Educational Rights and Privacy Act (FERPA)? If you haven’t done so already, you’ll need to find a vendor that understands the Medicaid program and all of its requirements. 
  1. Think ‘data integration.’ To bill for a potentially increased volume of Medicaid-covered services, schools must ensure that their billing vendor can streamline the process as much as possible. Has your vendor initiated meetings with various stakeholders to streamline data flow within the school nursing office along with other school departments? Or must the school absorb additional costs to enable that interoperability?
  1. Ensure that documentation is meeting standards. Schools will only receive additional reimbursement when all documentation and billing requirements are met. Specifically, documentation must include the following elements: School district name/provider number, provider credentials, student name, student date of birth, student Medicaid number, date of service, activity/procedure note (including whether the activity/procedure was performed individually or as part of a group), service time, and signatures. Note that thorough and complete documentation also mitigates the risk of a third-party audit.
  1. Seek out resources. For up-to-date information about school-based Medicaid billing, refer to the National Alliance for Medicaid in Education, Inc. (NAME). To learn more about compliant Public School-Based Medicaid Claiming, call Jennifer White at NEMB at 508-297-2068 x233.

 

About NEMB

New England Medical Billing is a leader in School-based Medicaid claiming and administration. We are a fully HIPAA-compliant Medical Billing Management and Administrative Service Firm. Our expertise is in program and system design as well as effective implementation and administration. Our multi-disciplinary approach and attention to detail consistently yields the maximum allowable returns on every client project.

Since 1993 NEMB has been built carefully, approaching each new engagement using proven management methods. Our superior, time-tested approach is applied to each and every engagement. We “zero-base” every new proposal to build a process that fulfills the unique requirements and goals of each project.

Our billing administration experience in ambulance & EMS services, emergency departments, school-based Medicaid claiming and private physician practices has honed and streamlined our clients’ operations in capturing and maximizing revenue opportunities on a large scale.

CMS rule reversal for Medicaid free care: Will additional reimbursement be on the way for Massachusetts public schools?2019-01-02T17:52:50+00:00

Community paramedicine on the rise

More than 75 million people live in rural (or partially rural) parts of the country that the federal government has designated as healthcare shortage areas, according to the most recent data from HHS. This means individuals in these areas may not have access to valuable healthcare services when and where they need those services the most. In addition, many emergency medical services (EMS) providers often respond to non-emergent situations. As a result, some states have begun to consider alternative solutions to bridge the care gap and reconsider the role of the EMS provider. Community paramedicine—a model of care that expands the role of EMS providers to meet healthcare demands—is one example.

What exactly is community paramedicine?

According to the Joint Committee on Rural Emergency Care (JCREC), community paramedicine “increases patient access to primary and preventive care, provides wellness interventions within the medical home model, decreases emergency department utilization, saves healthcare dollars, and improves patient outcomes.” It essentially allows paramedics to apply their training and skills beyond the traditional emergency response and transport model to expand the reach of primary care and public health services.

Various community paramedicine pilot programs have emerged nationwide as a way to address the Institute for Healthcare Improvement’s triple aim—that is, to decrease healthcare costs, improve health outcomes, and improve the patient experience. The industry may continue to see an increased focus on community paramedicine commensurate with the shift toward Accountable Care Organizations, value-based purchasing, and bundled payment models. That’s because in a community paramedicine model, EMS personnel work as part of the overall care team to deliver low-cost, high-quality, coordinated care.

For example, in 2012, Maine lawmakers removed regulatory barriers by authorizing up to 12 community paramedicine pilot programs throughout the state. Other similar programs have been initiated in Minnesota, Colorado, and Texas.

In Massachusetts, the Commonwealth Care Alliance (CCA)—a non-profit, pre-paid care delivery system for low-income and elderly or disabled beneficiaries—partnered with EasCare Ambulance, LLC to develop an Acute Community Care (ACC) model that relies heavily on community paramedicine. During the first 18 months of the ACC program, paramedics responded to almost 600 dispatches for the urgent care needs of more than 200 unique members. This model has been particularly helpful with these distinct clinical needs: members with urinary tract infections (UTIs), altered mental status/behavioral health conditions, respiratory distress, complex physical disability, and members nearing the end of their lives and engaged in CCA’s palliative care program.

However, to be successful, community paramedicine programs must foster collaboration among local stakeholders, including residents, elected officials, clinic and hospital administrators, and colleges/universities. This collaboration includes identifying best practices for funding community paramedicine programs. To date, many of these programs are supported through public and private grants. In addition, several CMS Healthcare Innovation Grant awardees receive Medicare fee-for-service for community paramedic services.

In Maine, municipal-based EMS agencies received funding for community paramedicine pilot programs as part of their regular EMS budget from the towns in which they were located. One private, nonprofit EMS provider requested a subsidy from its town. Ambulance services that were hospital-owned relied on the hospitals to absorb some or most of the cost of providing the community paramedic service.

Billing for community paramedic services also poses a challenge, as these programs must define a structure that works well for their individual needs. For example, the Minnesota Community Paramedics program sets forth various billing and documentation guidelines with the goal of tying services provided by a community paramedic directly to a physician. South Carolina follows a similar billing protocol.

Interested in learning more about community paramedicine? Consider these tips:

  1. Read up on resources. In 2012, the Office of Rural Health Policy published the Community Paramedicine Evaluation Tool to help communities establish a common framework for measuring outcomes and capturing data, both of which are a necessary part of competing for federal and state grants. The tool also helps communities assess needs and build partnerships to support a community paramedic program.
  2. Partner with the right billing vendor. Look for a vendor with a diverse background in billing for EMS, urgent care, and home care.
  3. Contact other community paramedicine programs. Inquire about the structure of the programs and how they overcame challenges along the way.

To learn more about our billing programs, contact Nancy Dolgin at NEMB at 508-297-2068 x232.

About NEMB

NEMB understands the importance of building meaningful relationships with entities and individuals within each municipality so we can ensure timely and compliant billing. Not only do we communicate regularly with fire and police departments, but we also take the time to get to know and network directly with town accountants, town managers, mayors, and others. We identify the key individuals within each municipality who can provide the critical information we need to bill ambulance services appropriately and as quickly as possible.

With nearly 10 years of experience in municipal ambulance billing, our credentialed staff members are trained in every aspect of effective municipal service billing. We specialize in auto accident claims that continue to challenge municipalities and result in significant revenue lost. We pursue auto accident claims as quickly as possible so our clients can take advantage of personal injury protection benefits before those benefits are depleted. Our expertise and focus on communication and relationship building help to maximize cash flow and ensure the fastest possible return on investment for the services provided. NEMB’s ambulance billing record has consistently yielded over a 90% collection rate.

Community paramedicine on the rise2019-01-02T17:52:51+00:00

Four Tips to Enhance the Collection of Copayments in Your Urgent Care Center

As many as 100 new urgent care clinics open their doors annually, according to the American Academy of Urgent Care Medicine. In an article published by the Healthcare Financial Management Association (HFMA), author Karin Kaplin writes that urgent care is projected to grow nearly 40%, to $18 billion, by 2017. And with each new clinic comes coding and billing challenges related to high-deductible health plans. Does the patient actually have active insurance coverage? If so, what is his or her specific copayment or deductible for urgent care services? This information is not always printed on the insurance card itself. Most importantly, how can front-end staff members educate patients about the ‘ins and outs’ of these requirements?

Collecting copayments is particularly challenging for urgent care centers that must meet Emergency Medical Treatment and Labor Act (EMTALA) requirements. EMTALA prohibits these centers from delaying screening or stabilization services to inquire about an individual’s payment method or insurance status.

According to CMS, provider-based urgent care centers may be required to meet EMTALA requirements if they are defined as ‘dedicated emergency departments.’ CMS defines these departments as those “held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment.”

Without a clear plan in place to collect copayments up front, urgent care centers subject to EMTALA may find themselves chasing after payments retrospectively. This creates an unhealthy accounts receivable from which it becomes difficult to rebound.

 

Consider these tips to keep cash flowing

Following are four tips that urgent care centers can use to enhance the up-front collections process:

  1. Provide staff education. Urgent care staff members can’t educate patients unless they, themselves, understand the nuances of various health plans. Can they clearly articulate the differences between a coinsurance, copayment, and deductible? Can they explain to patients why an urgent care copayment is usually higher than that of a physician office visit but lower than that of a ED visit? Create cheat sheets to address general or common questions, and keep insurance phone numbers handy when more specific questions arise. It also helps to get to know your provider relations representatives at each insurance company.
  1. Automate the eligibility process. Do staff members have online access to an eligibility clearinghouse or real-time eligibility tool? Some solutions use a provider’s internal data to estimate the cost of services that will be rendered. This empowers front-end staff to engage with patients about what they will owe and why. These solutions can also predict other details such as the deductible owed, copayment by service level, and lifetime wavers for particular services.

Note that your outsource coding and billing vendor may be able to provide low-cost or no-cost access to these types of tools and serve as a resource for billing questions.

  1. Communicate clearly with patients. This includes re-designing the center’s medical bill so that it clearly states the balance due using an itemized list of services and costs.
  1. Provide payment options. Make it as easy as possible for patients to pay for their urgent care services by accepting credit and debit cards as well as cash.

To learn more about compliant urgent care coding and billing, contact Nancy Dolgin at NEMB at 508-297-2068 x232.

 

About NEMB

New England Medical Billing is a fully HIPAA compliant Medical Billing Management and Administrative Service Firm. Our expertise is in program and system design as well as effective implementation and administration. Our multi-disciplinary approach and attention to detail consistently yields the maximum allowable returns on every client project.

Since 1993 NEMB has been built carefully, approaching each new engagement using proven management methods. Our superior, time-tested approach is applied to each and every engagement. We “zero-base” every new proposal to build a process that fulfills the unique requirements and goals of each project.

NEMB specialists, each of whom has been credentialed by the American Academy of Professional Coders (AAPC), have mastered the coding and billing guidelines pertaining to freestanding urgent care centers. We know what and how to bill services according to payer-specific physician contracts and can help our clients maximize appropriate reimbursement.

Four Tips to Enhance the Collection of Copayments in Your Urgent Care Center2019-01-02T20:40:13+00:00

Public School-Based Medicaid Claiming: Don’t let documentation leave you vulnerable during an audit

Documentation audits seem to be the new norm in healthcare, and public schools participating in Medicaid claiming are likely no exception. Although Medicaid hasn’t yet expanded its audits in this area, it is a possibility this can occur in the future.

According to a September 2015 report published by the Office of Inspector General, two Massachusetts school districts received overpayments due to cost reporting errors in FY 2012. The state Medicaid agency was required to refund thousands of dollars as a result of the investigation.

Going forward, state Medicaid agencies will probably keep closer tabs on public school-based Medicaid claiming programs. Medicaid wants to ensure that schools participating in these programs provide documented records of all Medicaid services that various school health personnel render. Schools must complete this documentation to receive reimbursement for all Special Education health-related Medicaid-covered services provided to Medicaid-eligible children. Services include speech therapy, occupational therapy, physical therapy, audiology services, counseling, nursing services, personal care, behavioral health, and applied behavior analysis (ABA).

If the documentation is omitted—or it doesn’t support the services billed—the school, state Medicaid agency, and/or the municipality in which the school is located could be required to refund the payment. It’s important for school personnel to understand their responsibilities in terms of providing clear and detailed documentation.

4 tips to secure compliant documentation

Consider these four tips to capture documentation most effectively:

  1. Remind personnel to document each time a Medicaid-covered service is provided to a student.
  2. Reiterate the importance of documentation. Although documenting services may take time and effort, the documentation is a critical part of compliance—and it could protect the school and municipality during an audit.
  3. Ensure that the documentation includes the following elements: School district name/provider number, student name, student date of birth, student Medicaid number, date of service, activity/procedure note (including whether the activity/procedure was performed individually or as part of a group), service time, and signatures. In the event of an audit, documenting the activity/procedure as ‘speech therapy’ is not advisable. Instead, encourage providers to document ‘Working with a student related to articulation of the ‘th’ sound for 20 minutes.’
  4. Don’t forget about ABA therapists. In July 2014, Medicaid announced it would begin to cover medically necessary treatment for autism, including ABA. It’s important to capture all documentation for ABA services rendered to Medicaid-eligible students.

 

Choose your billing vendor carefully

When evaluation third-party billing companies that will perform your Medicaid claiming, be sure to ask the following questions:

  • Can the vendor integrate with the school’s record system to access documentation easily and streamline processes?
  • Is the vendor willing and able to collaborate with information management solutions to develop an electronic system of tracking Medicaid billable hours?
  • Does the vendor review provider documentation to confirm that all required and relevant service data components are present?
  • Does the vendor have access to—and review—all individualized education programs (IEP) to compile a list of missing documentation for each student?
  • Can the vendor assist with obtaining, validating, and tracking parental authorization for Medicaid billing? Can it also assist with RMTS monitoring?
  • Is the vendor able to validate student and provider eligibility?

To learn more about compliant Public School-Based Medicaid Claiming, call Jennifer White at NEMB at 508-297-2068 x233

 

About NEMB

New England Medical Billing is a fully HIPAA compliant Medical Billing Management and Administrative Service Firm. Our expertise is in program and system design as well as effective implementation and administration. Our multi-disciplinary approach and attention to detail consistently yields the maximum allowable returns on every client project.

Since 1993 NEMB has been built carefully, approaching each new engagement using proven management methods. Our superior, time-tested approach is applied to each and every engagement. We “zero-base” every new proposal to build a process that fulfills the unique requirements and goals of each project.

Our billing administration experience in ambulance & EMS services, emergency departments, school-based Medicaid claiming and private physician practices has honed and streamlined our clients’ operations in capturing and maximizing revenue opportunities on a large scale.

Public School-Based Medicaid Claiming: Don’t let documentation leave you vulnerable during an audit2019-01-02T17:52:51+00:00

Increase Medicaid Revenue for Ambulance Services through Cost Reporting

Did you know that your municipality could potentially gain additional Medicaid reimbursement if it can demonstrate that its allowed costs exceed amounts reimbursed?  More than 35 Massachusetts municipalities with public ambulance/EMS services have already collectively gained approximately $4.6 million in Medicaid reimbursements.

According to the Ambulance Certified Public Expenditure (CPE) Program, approved governmental ambulance providers can submit an annual cost report and receive additional payment if allowable costs for MassHealth services provided on or after April 1, 2013 exceed interim payments. The program is administered by the state’s Executive Office of Health and Human Services.

“Our first responders are doing their part to protect the state’s most vulnerable residents, and these resources provide the additional support to help more individuals in need,” Governor Charlie Baker said in an HHS press release

Lt. Governor Karyn Polito echoed his sentiments. “We are proud to offer this extra level of support to our ambulance and public EMS workers. We hope additional providers and communities will take the initiative to participate and bolster support for emergency services around the Commonwealth,” she said in the press release.

However, even despite the availability of these funds, New England Medical Billing (NEMB) has found that many municipalities struggle with the program. Some decide not to participate because they incorrectly assume that the task of cost reporting will be too burdensome. However, depending on the municipality’s volume of Medicaid patients, we’ve found that 2%-10% of additional revenue is possible, making it worth the extra effort to pursue. Municipalities receive these funds once annually at the time of cost reconciliation.

To report costs correctly, municipalities must separate the administrative costs of the fire department from those of the ambulance services. This can be difficult, given the fact that operational overlaps often occur. For example, many fire chiefs know that a paramedic could drive the fire truck or a firefighter could perform emergency medical services.

Following are two tips to help you get started with the CPE Program:

  1. Ensure compliant billing. Work with an outsource vendor that understands ambulance the nuances of ambulance coding and billing. This helps avoid overbilling, and it ensures accurate reporting relative to costs and payments. Compliant billing also mitigates the likelihood of a potential overpayment in which the municipality would be responsible for refunding the amount.
  1. Tag costs for EMS vs. the fire department. Track the following:
  • Direct service staff salaries (e.g., paramedics, EMTs)
  • Ambulatory services administration salaries (e.g., non-direct service staff)
  • Direct service support staff salaries (e.g., 911 call techs, QA techs, billing/account reps)
  • Benefits for direct service staff/administration staff/support staff, operating expenses (e.g., fuel, maintenance, repairs, plant operations, utilities)
  • Equipment depreciation
  • Equipment costs

To learn more about the CPE Program and how it can potentially yield greater reimbursement for your municipality, call Nancy Dolgin at NEMB at 508-297-2068 x232.

About NEMB

NEMB understands the importance of building meaningful relationships with entities and individuals within each municipality so we can ensure timely and compliant billing. Not only do we communicate regularly with fire and police departments, but we also take the time to get to know and network directly with town accountants, town managers, mayors, and others. We identify the key individuals within each municipality who can provide the critical information we need to bill ambulance services appropriately and as quickly as possible.

With nearly 10 years of experience in municipal ambulance billing, our credentialed staff members are trained in every aspect of effective municipal service billing. We specialize in auto accident claims that continue to challenge municipalities and result in significant revenue lost. We pursue auto accident claims as quickly as possible so our clients can take advantage of personal injury protection benefits before those benefits are depleted. Our expertise and focus on communication and relationship building help to maximize cash flow and ensure the fastest possible return on investment for the services provided. NEMB’s ambulance billing record has consistently yielded over a 90% collection rate.

Increase Medicaid Revenue for Ambulance Services through Cost Reporting2019-01-02T17:52:52+00:00

Urgent Care Billing: In House or Outsource?

One of the most important things that an urgent care center needs to consider is whether to outsource their billing or take care of it in-house. While in-house medical billing does give a practice more control over their billing practices, many urgent care clinics find that it’s more trouble than it’s worth.

As strange as it may sound, it’s in your best interest to outsource your urgent care clinic’s medical billing to a third party. Here are just a few reasons why.

Consistent Billing

Unpaid or denied claims are common for any medical practice. These can cause a major headache for obvious reasons, not the least of which is the time and effort it takes to address these claims. A medical billing company is contractually obligated to follow up on these claims, which takes most of the stress away from the urgent care clinic itself.

Having a third party handle all billing claims also means that all bills will be sent out on time and at a regular basis. Clinics that handle their billing claims in-house can easily fall behind on their bills and claims if they have a heavy workload. Medical billing companies focus exclusively on billing patients and sending claims to insurance companies, which means they don’t have to worry about treating patients or taking care of any other responsibilities that could cause them to fall behind on their work.

Transparency

Medical billing companies also submit performance reports to a provider upon request. These reports provide transparency and allow a clinic to know exactly where it stands financially. This also allows an urgent care clinic to evaluate the services of the billing company itself.

Lower Costs

While it can be difficult for urgent care clinics to budget for medical billing companies, outsourcing medical billing can still lead to lower costs for clinics. An urgent care clinic that handles all of its billing in-house simply has a higher overhead. A billing department needs to be created, which means having to hire more employees and paying more in hourly wages and other benefits. There’s also the matter of creating a billing system, which can eat into the clinic’s budget even further. On the other hand, outsourcing work to a medical billing company allows an urgent care clinic to bypass all of this and simply focusing on other matters.

Education

The experience provided by a medical billing company is unparalleled. Since medical billing is at the forefront of the business, medical billing companies have lots of experience in this field. In addition, they are well versed in all the rules and regulation of medical billing.  This minimizes room for mistakes and allows practices to feel confident in the ethics and experience of the medical billing company.

Better Service

Finally, outsourcing billing and claims to a third party allows an urgent care clinic to provide better service to its patients. Doctors and other medical professionals don’t have to worry about processing claims and sending out bills, so they can focus on providing high-quality treatment to those who need it. They may not have all of their billing information on hand at all times, but they can rest assured that it is in good hands while they focus on doing their jobs to the best of their ability.

Urgent Care Billing: In House or Outsource?2016-07-11T16:26:21+00:00