I am a big believer in policies and procedures. I preach the importance of having good policies and procedures in my talks and when working with clients. My advice usually goes, “make sure you develop a policy to address the issue.” Yup, I like policies. Well, most of the time. Except when they come back to bite - especially when the person who got bit was me.

Let me tell you a story of policies gone awry. Then I’m going to tell you how this kind of thing also happens to ambulance providers. I’ll finish up with what you can do to assure your policies don’t come back to bite someone, say your patient or even you.

My personal life has a whole lot of healthcare going on lately. I’ve written about my son who awaits kidney transplant while enduring dialysis treatments. I see a lot of healthcare as I help care for him. Recently, my husband was diagnosed with prostate cancer. Fortunately, this kind of cancer is very treatable, but it still involves healthcare services. It’s also still cancer, an anxiety-producing word if there ever was one.

On the morning of my husband’s scheduled robotic surgery to remove the prostate, we arrived early at the hospital. All necessary testing and prep had been done. We knew his probable rate of recovery and cleared our calendars to accommodate his needs. He dressed in hospital attire, an IV was started and antibiotics given. We waited for his turn. And waited. And waited. A couple hours after scheduled surgery, we were told that there had been complications with the patient before him and it would probably be a few more hours until the problems were resolved. Consequently, they recommended we reschedule.

Imagine being prepared for cancer surgery only to have to reschedule. That was tough enough, but how the policy aspects of the situation evolved was downright infuriating. When they cancelled surgery, we were told it would be promptly rescheduled. Nope. We were told that there were policies involving the scheduling of the robotic surgery and we would have to accommodate their needs. (I tried to escalate that situation without success.) Surgery rearranged and we were told my husband would have to take all the same tests and steps again. When we asked why, we were told that this was the policy and all part of their “process.” We pushed back by saying that all information was quite recent and readily available in their system; we were told that re-doing this was their “process.” After a bit of wrangling, we learned the “process ridiculous” reason – they had opened a new file number! Oy! Because the hospital opened a new file number, they expected a time-consuming and uncomfortable re-do. Each attempt by us to change the situation was greeted with, “but it’s our process” or “we have a new file number.” Last but not least, we learned that the staff was aware that there were time-consuming complications when we arrived, but we were not alerted because it was their policy to wait.

I know what you’re thinking; why the heck didn’t they ditch that hospital and go someplace else? Because my husband has confidence in the doctor. Going someplace else would not fix the over-reliance on “process” as the excuse for why we do things. Furthermore, this is actually a pretty darned good hospital (living where I do, there are many options and this is a good option).

Like I said earlier, I routinely see this kind of problem with “process” and policies. Common examples in ambulance billing:

·         “We always bill for denial before sending the bill to the patient.” Why? If it’s a non-covered service, bill the patient first. You may get paid more quickly. If the patient requests a denial, of course you should bill for denial. But being wed to this type of policy can delay cash flow.

·         “We always let the patient tell us what they can afford to pay.” Here’s a place where you do want to set a policy – establish a minimum amount monthly that you will accept. If the patient truly is unable to pay, consider financial hardship.

·         “If a paramedic was on board, we bill ALS.” Now there’s a slippery slope.

There are many other examples. Now would be a good time to look at your policies. Do you have too many work-arounds? If so, your policies may need to be reconfigured. Are your policies human? Do they respond to the needs of your patients AND the needs of the staff? If you are the biller, do you tell your manager when a policy does not work, or when you are working around it too often?

Remember, I advocate policies. But you also need a way to escalate when the policy does not work. Staff needs the ability to exercise some critical judgement of the situation.  Policies and procedures are a great comfort to us; they help us do our jobs and give us guidance. Just make sure that your policies are not causing more harm than good.

Let us know if we can help.

About the author:  Maggie Adams is the president of EMS Financial Services, with over 20 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. Check out our newest documentation training webinars and billing webinars on our website.Friend EMS Financial on Facebook, or for more info, contact Maggie directly at maggie@ems-financial.com or visit www.ems-financial.com