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Stalwart Leadership: Ambulance billing is a specialty with intricate guidelines requiring a team of robust experience and knowledge to handle the process. The success of any process depends upon the team we create and Rely on us has such a promising team who would inevitably bring a phenomenal change in your business revenue in-flow and we have proven records that set standards for our credibility.
Transition Strategy: We have live examples with our existing clients where we had come up with exclusive strategies for a smooth transition from onshore.
Consistency: With the dynamism the ambulance business runs with, we are capacitated with a stable team with low or no attrition ensuring we maintain the consistency in our deliverables.
Emergency medical services Ambulance coding though sound to be easy, it has its own intricacies when it comes to billing a trip. There are many steps involved to end up with clean coding and billing.
✔ Verifying patients demographics (Patients first and last name, SSN, Residence address)
✔ Insurance verification process
✔ From and to location modifiers (HH,NH,RH, SH)
✔ Mode of Payment, checking authorizations
✔ Type of transportation (Emergency or Non-emergency)
✔ Level of service determination (ALS,BLS,SCT or CCT)
✔ Signature requirement
✔ Physician certification statement
✔ Medical Necessity
✔ Condition code
✔ Charge entry (respective procedure codes)
Challenges associated with Ambulance billing
Billing to incorrect Payers and incorrect sequencing: Verification of patient’s insurance eligibility and billing to the correct payer play a significant role in ambulance billing. It is also expected from the coders to bill as per the order of priority when it comes to billing to the payer (VA>MCR HMOs>MCR> Commercial >Medicaid HMOs>Medicaid). Submitting claims to incorrect insurance inevitably leads to a delay in payments affecting the revenue of the EMS drastically.
Inappropriate condition code: Unlike medical coding, ambulance coding does not support diagnosis coding since paramedics are not licensed and it is beyond their scope of practice to assign a diagnosis. Paramedics can only document the condition present on arrival. Most denials happen because of the incorrect selection of condition code which does not correspond with the documentation available or level of service performed.
Lack of medical necessity: To assure transport is medically necessary, coders must consider both the patient’s condition and the method of transportation. This can be a challenging process, which depends on the documentation, paramedics and emergency medical technicians (EMTs) provide in the field. It is crucial for the ambulance coders to determine the medical necessity of the trips. Most of the times it so happens that patients call for ambulance while they do not require any medical monitoring. The same transport can take place through a private vehicle too. However, coders fail to differentiate such scenarios and assign a condition code for almost all the trips. This leads to a serious compliance issue for billing the trips without medical necessity resulting in the payers levying heavy penalties.
Emergency vs Non-emergency: Although the provider education and use of sophisticated software has phenomenally improved the quality of electronic health records, there are still gaps in the ambulance billing failing to figure out the correct type of transportation, emergency or non-emergency (ER or Non-ER). The knowledge of the coders play a very important role in bringing to the provider’s attention the technical gaffes in the system ensuring billing is in compliance with the guidelines.
Location Modifier Selection: Major challenges have emerged due to the inability to comprehend the patient care reports (PCRs) ending up assigning incorrect modifiers. Appending the right to and from location modifiers play a crucial role in deciding whether the trip is covered or non-covered.
Impact on revenue through Level of Service: Of late, the paramedics are using acronyms for critical care transport (CCT) procedures. Due to the random usage of acronyms, instead of holding the trip for clarification, coders are downgrading the level of services causing huge revenue loss. Coders would have to look for the details of what is included in the CCT procedures and ensure capturing only the appropriate procedures that can be billed as part of the ambulance services. Few frequently used acronyms which are indicators for CCT:
FFP: Fresh Frozen plasma
CVL placement: Central venous line
CT monitoring: Chest tube monitoring
CPR: Cardiopulmonary resuscitation