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

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

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