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:
- Ask a loved one for demographic information before or during the transport itself.
- Obtain information from the hospital emergency department at the time of transport.
- 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.
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.