The paramedics’ team and other healthcare professionals who work for the Emergency Medical Services (EMS) Department mostly handle the Ambulance Billing section. While they may not appear as a problem, coding and billing require professional knowledge, making it difficult for paramedics to operate effectively. In addition, you cannot keep up with the billing necessities with new codes and the changing healthcare guidelines.
As a result, you may encounter claim denials or rework for bills and claims, making the entire process time-consuming. Most of the time, you do not understand the calculation for the emergency ambulance billing works. While you have been in an uncontrollable situation, it gets worse with the bills that you receive at the end.
How Does Emergency Ambulance Billing Work?
When an EMS provider responds to a distress call by sending off an ambulance, the crew will take down the patient’s information and confirm their identity. These particulars will include but do not limit to:
- Social security number, phone number, address, and name of the patient
- Date of birth of the patient
- Details of the patient’s health insurance
- Information of employment if the worker’s compensation covers the patient
These details are forwarded to the billing team of the ambulance billing company. They cross-check the procedures followed and services provided to the patient. Then, they will use this information to run an insurance eligibility verification and create a bill and insurance claim.
Further, the team will accurately code and file for the claims of the insurance as soon as possible. The emergency ambulance billing company then regularly reviews the insurance claim status to see if it has been approved, denied, or rejected. Next, the company takes appropriate steps for rejected and denied claims.
Guidelines on Billing
Any ambulance services provided by a private carrier must be billed using the CMS-1500 form. Services offered by a hospital-based carrier must be billed on the UB-04 form, with the NPI (National Provider Identifier) assigned to ambulance services. Therefore, they cannot bill these services using the acute hospital NPI, and hospital-based ambulance services will not accept any inpatient claims.
The provider of emergency services, here Ambulance, relates to the non-contracted service provider. If you request to get the services under the “Emergency” title, you may have to make the payment in full. This refers to the amount as mentioned on the emergency ambulance bill. They will stabilize or evaluate each bill on the basis of the emergency medical condition of the patient. Bad demographics may lead to non-contractual services. However, you will have to pay the rates as applied by the state Medicaid program.
The bill calculates against the mileage scenarios. That means, it considers the distance beyond the closest medical facility. These miles will be collated for the Units field. However, if the ambulance members treated the patient but did not transport during the emergency, you should file the A0998 form.
For any further assistance on ambulance billing, you can get in touch with NEMB. The experts comprise a team of billers and coders who have assisted several clinics and hospitals in increasing revenue and overall billing.