Blog Categories  /  Compliance

Use of Bad Words in Trip Reports & Billing

Remember Ralphie, the boy from the movie Christmas Story? Ralphie had many adventures working his way to Christmas Day including the day he used bad words in front of his mother. Her response to the bad words was to make him sit with a bar of soap in his mouth. Times have thankfully changed, ...

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How to Say "No" to the Boss

This week an ambulance company owner was convicted in Texas of a $3 million fraud conspiracy.  In addition to billing for van transports as ambulance trips, the OIG press release about the conviction noted the owner had “instructed a licensed emergency medical technician (EMT) to creat...

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Reasons to Never Audit Ambulance Billing

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. ...

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Building Blocks of Billing & Compliance

Routinely, we are asked questions about the nuts and bolts of billing, documentation and compliance. This week’s questions addressed levels of service (how to document and how to bill), facility payment delay tactics, and the obligation to pursue patient balances.   It’s ...

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Jump into New Ambulance Compliance Era?

Hold onto your parachute! Do you wonder if the new year will herald the dawn of a new era of healthcare compliance? Will ambulance providers have less to worry about when it comes to fraud and abuse oversight? Not likely. As talk and speculation swirls about what could potentially happen to h...

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Ambulance Provider? Financial Risk Ahead

If you provide and bill for medical transportation services of ANY kind, you need to be aware how high the government just raised the stakes for compliance. Last week we told you about the intense focus on ALS-1 emergencies. If you do emergencies, or take trips in/out of skilled nursing facilitie...

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Be Compliant Strong!

It’s summertime - the July 4th holiday passed, many are on vacation and before we know it, fall will be upon us. Fall always arrives with an uptick in activities, both personally and professionally. With the arrival of vacation season, many people find that the office has gotten a bit quiet...

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EMS Documentation & Billing Problems Persist

Summertime and the living is not as easy as you think. Due to vacations and holidays, there may be changes in crews or a juggling of the people who normally perform billing functions. Whether field provider or biller, both parties have a responsibility to do the right thing (even when we are dist...

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Keep Your Medicare AND Medicaid House in Order

The headline on the news today was “Hundreds Arrested for $900 Million Worth of Healthcare Fraud.” Although there were arrests in many states across the country (like Pennsylvania, Ohio, Louisiana, etc.), the top states for arrests were Florida, Illinois, New York, Michigan, Californi...

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Emergency Billing Under Fire

For a long time, the focus seemed to be on non-emergencies only. The hot button item was always “medical necessity.” Providers need to assure that the patients they transport by ambulance cannot travel by any other means. It seems that lately the focus has expanded to include emergenc...

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Ambulance Audit Danger Near

Is your service in the danger zone for potential audit scrutiny? Unlike “American Idol” or “The Voice,” there are some top of class lists where you don’t want to be included. Unfortunately, for ambulance providers, that’s not the case with the release of CMS&rs...

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Best Ambulance Software & Ambulance Billing Companies

Many of you heading to EMS Today in Baltimore this week will check out the vendors including billing companies and EMS software vendors. In the past couple weeks, I've been asked two questions repeatedly - the first is what's a good billing software company and the second is, should I out...

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Common Documentation & Billing Problems

Here are two common documentation and billing errors we routinely see in both the emergency and non-emergency ambulance world. Emergencies We see an increase in hospital-to-hospital transports billed as an ALS-1 emergency. When we read the trip report, the documentation may note the patie...

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Questionable Billing for 1 in 5 Ambulance Suppliers

This is not good. Not good at all. The Office of Inspector General (OIG) released a report on September 28, 2015 that major problems continue to exist in the ambulance industry. The OIG cited “inappropriate payments and questionable billing.” The most prevalent billing and documen...

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Plans for More Aggressive Fraud Focus

I bet you thought the arrival of ICD-10 on October 1st was going to give you enough heartburn as you juggled getting crews and billers ready for this event. So what about the rest of your billing issues? Did you know that increased fraud oversight was headed your way? Just last week in my bel...

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Less Fraud Oversight?

Is it possible that fraud and abuse oversight has LESSENED? Can we expect fewer audits and less oversight of our documentation and billing efforts? The numbers from the OIG make it appear so, but there is more to the story than meets the eye. The approach to fraud and abuse is changing and ambula...

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Tripping Over Auditors

Everywhere I travel, ambulance providers are tripping over auditors.  In the 20+ year history of my career, I have not seen activity like this. Non-emergency providers are most decidedly getting reviewed, but more and more, we are seeing 9-1-1 emergency services scrutinized as well. The foll...

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Ambulance Claims Audits: Why, How & When

During recent audits, we found an insurer who had underpaid our clients. Naturally, the clients were thrilled to learn they were due more money. Yes, money is important, but there is much more to be gained from performing routine claims audits. This piece will outline the why, how and when of amb...

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One Step Forward

Bad news first. Ohio ambulance providers face potential surety bond requirement.  Could you be next?    A Medicaid audit in Ohio showed that the State could save $10 million per year if it required surety bonds from ambulance and ambulette providers who are considered most like...

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Fraud Strike Force

  Your ambulance and billing company need an active, living, workable compliance plan. That plan needs to be readily available to all your staff, they need to be trained in its critical importance, and top management must routinely monitor its performance. It’s the right thing to d...

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