Unless you have been living in a Wi-fi-free area for the past several months, there is no way you do not know that it’s election season. The time of year got me thinking about what our politicians do for the EMS industry. Don’t worry; I’m not going to talk about anything political. What I am going to do today is present new and different ways for you to look at your LOCALLY elected officials to help you in your DAILY ambulance documentation and billing efforts. Whether you struggle with Medical Assistance billing or you question how much in interest you can charge on an unpaid bill, or you need to know what the expectation is for records retention, there are many ways in which your local representative can help you.  It can be very challenging to navigate your state’s website to get all the information you need to do your job. This is even more important if you are a billing company or you bill patients in more than one state. Here is a list of ways in which your local politician can help:

Medicaid Managed Care Problems

Medicaid managed care is widespread. The issues you face range from problems with claims processing systems to knowing what to expect from the plans. Examples of ways your state representative can help you are:

·         Any state with Medicaid managed care has a contract in place with the managed care plans. That contract notes what types of service are covered (for example, emergency medical transportation services or medically necessary ambulance transport). The contract also notes how managed care plans are supposed to handle appeals and the timeframe in which clean claims are to be paid. However, finding that contract can be difficult or locating the specific provisions in the contract that apply to you may not be easy. Touch base with your local state representative for help finding the contract language you need to know so that you get proper reimbursement for Medicaid managed care transports.

·         Medicaid managed care may have prior authorization requirements or special forms requirements. Again, check with your local representative to find out where to access the forms you need.

·         Most important, keep your local representative’s office updated on the issues you face when processing claims with the plans. Contracts with the payers do come up for renewal. Representatives need to be kept abreast of the issues in regards to working with the plans or with transport brokers.

Finance Charges

State law regulates if you can charge interest or finance charges on unpaid medical bills. The amount of interest you may charge is also regulated by state law. However, to learn what amount of interest you are permitted to charge means that you have to crawl through the state’s regulations on the topic. Contact your state representative and have them either send you in the right direction to find the information you need or ask them to send you a link to where the information is available online.

Prompt Payment Provisions

My home state has rules that govern managed care plans – clean claims are supposed to be processed within 45 days or interest is due. Make sure you know when payers are supposed to pay you by getting the information from your state representative.

Can You Balance Bill Patients?

California just passed a new rule in regards to balance billing patients after insurance has paid their portion of the bill. This is a very important topic for providers. Make sure you know what your state allows in regards to balance-billing of patients. Each state is different.

Insurance Commissioner Complaints

Every state has a method of escalation when there are problems with payers. In some cases, a provider may take an issue straight to an insurance commissioner; in other cases, there may be a series of steps that must be taken (or forms to be completed) before filing a complaint with an insurance commissioner. This is another area where your state representative may be helpful.

Last but not least, let your representative’s office know the daily struggles you face in rendering service, documenting those services, coordinating information flow with the state and billing in your state. These folks make a difference to your daily work life. Be vocal and let them know about the impact that the state’s rules have on what you do.

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