Medical Billing

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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

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