What You Should Know About Documentation & EMS Billing

1. What You Should Know About Documentation & EMS Billing Anthony Minge, MBA – Director MedServ Patient Account Services

2. Who Is Responsible for… • Compliance? • Gathering Documents such as PCS, PAN, Face Sheets? • Billing? • Follow Up?

3. Areas We Need To Focus On • Obtaining Information at Dispatch • (PCS, PAN, Payment Info for Non-Covered) • Verification of Information at Time of Transport • Gather Documents (face sheets, EKG strips, insurance info if applicable) • Attaching them in a format that is easy to use • Not multiple patients on one scan • Document Right Side Up

4. What does this do? • Increases Net Revenue • Improves Cash Flow • Reduce Risk by Ensuring Compliance

5. Increasing Net Revenue • Capture All The Transports • Is a Treatment Billable? (even if we don’t transport the patient?) • Ensure Transports Meet Criteria for Emergency ALS1 Assessment • Optimize Service Levels Appropriately • If you did it, document it…so you can get paid! • Don’t up-code or falsify documents • Review Your Document • Send the Information in a Timely Manner

6. Capturing All Transports • Reconcile Dispatch with the Paperwork (make sure you have paperwork for what was done) • A daily Trip Log for the billing department • Fulfill the Pre-Requisites • PCS Forms • Prior Authorization • Medical Necessity

7. Emergency Response • Emergency response is a BLS or ALS1 level of service that has been provided in immediate response to a 911 call or the equivalent. An immediate response is one in which the ambulance provider/supplier begins as quickly as possible to take the steps necessary to respond to the call.

8. What is Billing Doing? • Private Pay • Retro-verification for Medicaid Eligibility • Coinsurance & Deductibles • Commercial Insurance • Government Programs • Medicare • Medicaid • VA & Tricare

9. IMPROVE CASH FLOW • Timeliness of Processes • Ensure Clean Claims & Reduce Denials • Make It Easy To Pay

10. Timeliness of Processes • Timeliness of Processes • “48 Hours – Out The Door!” • Getting Clean Patient Care Reports to Billing • Be Complete & Thorough In Documenting Trip Reports • Use Technology • Electronic versus Paper • Auto Insurance • Fax the Invoice

11. Ensure Clean Claims & Reduce Denials • Good Source Documentation From Dispatch & Crew PCR • Accuracy of Data Entry & Coding • Follow The Rules • Be Accurate & Objective • Verification of Insurance Coverage • Identify & Document Medical Necessity • At Dispatch, In The Field & Final Verification In Billing

12. Ensure Clean Claims & Reduce Denials • Results of Clean Claims • Reduces Denials • Reduces Rebilling to Additional Insurance Companies (Because you did not verify the first one) • Increases Prompt Payment • Allows For More Time For Follow Up on Static Claims and Problem Payers

13. Make It Easy To Pay • Make It Easy To Pay • Electronic Funds Transfer • Credit Cards • Online Payment Systems

14. REDUCE RISK • Pay Attention • Know The Rules • Customer Service

15. Pay Attention To • Productivity • By Company/Department/Base • By Individual • Performance by Payer • Are they dropping off • Slow Pays • Paying at Contracted Rates

16. Know The Rules • Implement a Compliance Plan • Audit Accounts • Err on the Side of Caution for Medical Necessity & Level of Service • Use CMS Medical Conditions List

17. Customer Service • Customer Service • Positive Relationships • Payers • Facilities • Patients • Strong Relationships • SNF • Get a weekly list of who is covered on Part A • Who is ensuring your PCS forms are completed.

18. Conclusions • You Want to Ensure You are Getting The Money That is Due To You for the Services You are Providing. • Know “What” needs to be done • Follow Up, Follow Up, Follow Up • Pay Attention

19. This Session is CEU Approved http://www.surveymonkey.com/s/NAAC_Certs

20. Questions/Contact Info Anthony W. Minge 303 Marshall Rd., Box 170 Platte City, MO 64079 816-903-4916 aminge@medserv.us www.medserv.us