As a front-line provider, understanding how your service gets reimbursed for the emergent services provided might not seem relevant or worth your while. The return on investment is greatly tied back to the medic or EMT's documentation, specifically its completeness -- including those pesky signatures as care is being transferred at the local emergency department. This blog will center on how you can play a part in both maximizing revenue and maintaining overall compliance with regulatory agencies. For your convivence I had provided a non-exhaustive top 10 list below: (they are in no particular order)
1. At the conclusion of the call, make a good faith effort to obtain a signature from the patient or a designated representative. This is necessary for claim submission purposes, and Medicare implementation of this rule happened in 2007.
2. Try to obtain a basic understanding of ICD-10 codes. EMS care is becoming more data intensive than ever before, and the ICD-10 codes have great utility. In a nutshell, ICD 10 codes are used to describe diseases, signs and symptoms, complaints and external causes or injury. The concentration is on your provider impression with signs, symptoms and reasons to support. Medical necessity matters!!
3. Consider establishing a dedicated QA/QI system. Oversight on our documentation is a good thing, it helps validate our work and look for areas of improvement. From a billing perspective, ensuring the data is accurate will likely lead to quicker processing times and less rejected claims.
4. Most agencies are utilizing an ePCR to complete the patient encounters, leverage this software for good. Build the necessary validation rules, customize the user experience. It may seem like a pain at first, but this work will streamline the process on the backend. Checklist, and drop downs can be a great asset in your clinical documentation journey and help on the revenue side of the house as well.
5. Explore ways to integrate with your local hospitals. Bidirectional data sharing is quite helpful, and HIPAA actually promotes this for payment related purposes. The hospital wants your run sheet in a timely manner. You would like to have billing, demographic information and some clinical follow-up, right??? The synergies here are endless and the technology to interface has been out for at least a decade.
6. Become familiar with this website - Ambulances Services Center | CMS -- there is a plethora of information right at your fingertips. Including those all-important fee schedules. Regular updates are also posted here quite frequently.
7. Regularly review your billing and collections histories and trends across fiscal years, bi-annually etc... where are the areas for improvement. Have lots of unpaid claims > 90 days old?? Could external consultation from known and established experts help your agencies bottom line?
8. Your agency likely has some key performance indicators (KPI's) around response times, intubation successes, stroke scale compliance....etc. Do you or your 3rd party billing company have billing KPI's? Are you familiar with them?
9. Hey, another potentially helpful website - Medicare Incorrectly Paid Providers for Emergency Ambulance Transports From Hospitals to Skilled Nursing Facilities Audit (A-09-18-03030) 09-11-2019 (hhs.gov) - lots of advisories from the Inspection General (OIG) come directly from here..
10. Take the patient to the closest appropriate destination and – if not – thoroughly document the reason for transporting them to a more distant location. Don't fudge the loaded/transport miles. This should be documented to the nearest 1/10 mile if you go < 100 miles. If the trip exceeds 100 miles - the nearest whole number is acceptable.
August 14, 2023
Author: Joshua Ishmael, MBA, MLS(ASCP)CM, NRP
Pass with PASS, LLC.