There’s a lot of anxiety since the announcement of Medicare’s plan to target ambulance providers with small audits in their “TPE” effort (Targeted Probe and Educate). There’s nothing to worry about. The last thing providers should do is rush to audit themselves.

Sure, ambulance services don’t get paid for every trip, but by and large, things go smoothly. There is absolutely no reason for ambulances to audit trip reports and billing. The reasons to never audit include:

Crews are good people; they probably do a decent job at documentation

The billing staff was trained; they know what they are doing

Nobody says an ambulance service “has to” audit themselves

Everyone in the company understands the ins and outs of Medicare

No one in the company has been audited by the government, CMS, or the OIG; they never even met someone from the FBI

Providers make enough money

A billing company does the billing; they know billing best, and,

Auditing trip reports and billing can be a pain

Right?  WRONG!! When done right, a billing audit can save an EMS provider money. With the announcement of TPE audits and the recent (and ongoing) intense review of emergency services, now IS the time to take a closer look at how things are done. A billing audit is the best way to ensure compliance and billing accuracy. An audit is to quickest method to make sure you are not under-paid for service. Even more important, an audit will uncover any overpayments.

Though no one says a provider “has to” do internal or external audits, it is recommended by the OIG in their Compliance Guidance to Ambulance Suppliers. It is far better to find a problem on your own rather than have the problem found by regulators. A problem found allows the provider to act – whether that action is to correct and resubmit the underpaid claim or root out the cause of the overpayment and promptly return the funds.

Advantages of External Audits 
Trained billing staff is the best tool for getting paid and the best defense against fraud or abuse. But healthcare is a fast-paced business. Things change rapidly.

I strongly advocate doing routine internal audits. I’d be happy to teach you how to do it. But that’s the first step in the process, not the whole process. External audit reviews complement and enhance the internal program. An external reviewer is objective. They bring a fresh set of eyes to the claims.

The internal review team knows the importance of reimbursement and the worry the organization has about money. Occasionally, an internal reviewer’s recommendations may get overlooked. An external auditor has no conflict of interest. The auditor may validate the excellent work of the billing staff or recommend steps to improve the process and increase productivity. Audits can save money. Mistakes can be caught early, education can be provided, or an internal process can be improved.

Furthermore, external auditors have seen many, many claims from all kinds of ambulance and billing entities. Their experience and objectivity will quickly pinpoint problems. Cash flow can be improved by finding under-coded or under-paid claims. Denials may lessen after feedback from an external review. Over-billed and over-paid claims can be decreased with the knowledge gained from external audit. Most important, compliance can be maintained…and good compliance is the best thing a provider can do to assure they get the cash they deserve and get to keep it.

Routine external auditing serves as the icing to the cake of your internal audit program. An annual external claims review is recommended.

We all know the payment and compliance horizon is not going to get any easier. Taking steps now through an internal and external claims review program will help you weather both challenges. Let us know if we can help!

About the author:  Maggie Adams is the president of EMS Financial Services, with 25 years’ experience in the ambulance industry as a business owner and reimbursement and compliance consultant. Known for a practical approach and winning presentation style, Maggie has worked with medical transportation providers and billing companies of all kinds to support their billing, auditing, and documentation training efforts. “Like” EMS Financial on Facebook, follow us on LinkedIn or for more info, contact Maggie directly at maggie@ems-financial.com or visit www.ems-financial.com