I received four calls recently from emergency providers who complained about growing denials, large unpaid accounts receivable and skyrocketing patient balances. Yet I recently read that uninsured rate in U.S. is down dramatically with only 8.8% of population currently without insurance. If so many more people have insurance, why aren’t emergency ambulance services getting paid? Let’s talk about some of the reasons why and what can be done to improve your results.

In the emergency world, three things delay payment – lack of patient signatures, no insurance or good demographic information, or claims that go to the wrong payer. Two of those issues involve your crews while the problem with wrong payer may be traced to billing.

Not Every Emergency is Life-Threatening

For crews, it is imperative that patient care always come first. Obviously, some emergencies are so critical that it is impossible to seek detailed demographic or insurance information. But many emergencies do provide an opportunity to get good name and address information (including a check of spelling). There are also times when a Social Security number, Medicare ID number or insurance information can be captured. We see documentation that family members reported the history of the incident or the patient’s past medical history. Family want to help. If available, check with family members or people at the scene.

Encourage crews to ask the spouse or family for the proper spelling of the patient’s name. This is also a good time to ask them to sign on behalf of the patient. In our audit work, we routinely read trip reports that describe the information provided by the patient’s daughter or the nurse’s aide at the facility. As we continue to review the trip documents, we later see that no patient or representative signature was obtained from the same person who gave background information on the patient.  

Provide quick refresher training session to crews on the signature regulations. We meet emergency crewmembers who believe all is well if they grab a face sheet at the hospital or get someone in the receiving facility to sign. Remind the crews who to ask to sign if the patient is physically or mentally incapable of signing.

There’s an old expression, “get while the gettin’s good.” This is especially true when trying to get valuable signatures, demographic information and insurance information at the time of the call. When signatures or information is not obtained at the time of the call, a patient may be burdened by bills and paperwork after the event when they are trying to recover.  

The patient’s burden impacts the provider as well. No claim may be sent without proper signatures or payer information. Consequently, the provider’s outstanding self-pay balances grow and cash does not flow. Routine refresher training may improve these issues.

Billers Run with the Wrong Info

Billers get so excited when they are lucky enough to have insurance information in hand. Sometimes they run with that information. This is an approach that may lead to denials. There are two steps that must be taken prior to using that valuable insurance information the crew captured. First, use online resources to verify that correct and current insurance information was obtained. Next, never assume that Medicare or Medicaid are the appropriate payers. Regulated payers like Medicare and Medicaid are payers of last resort. When insurance information gets verified, ascertain if another third-party hold liability for the claim.

Was the patient in a car accident, slipped in a store or on their neighbor’s sidewalk? If so, someone other than Medicare may be the appropriate payer. Failure to send the claim to the right payer means that billers must do the same work twice. The denial must be worked. The claim will need to be resubmitted to the correct payer. Unfortunately, time may have been spent on online or phone call follow-up and cash flow gets delayed.  Again, the patient may catch the worst of this problem when the unpaid bill gets sent to them.

Better Than Self-pay

The world of health insurance has been in quite a whirl but we still live under the Affordable Care Act with its accompanying list of “Essential Health Benefits.” One of these benefits is emergency coverage. With a larger portion of the population covered by insurance with emergency benefits, it is crucial that providers learn who that payer is and have the proper signatures in place to be able to bill those payers. Encourage your crews and billing staff to take the few moments of time needed to meet those goals.

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