During 2019, I traveled over 100,000 miles working with providers and billing companies of all kinds. Along the way, I’ve seen new ideas and heard rumblings that concern me for our industry. Here is my list of topics to monitor for the upcoming year:

The CMS Cost Data Collection project is important and must be addressed. That’s common knowledge. If you need help, don’t hesitate to seek it. There are resources available. Enough said.

If you didn’t qualify or apply for ET3, don’t worry; CP payment is possible. ET3 is cool, but far off and limited to a small group. However, many across the country are doing CP in one form or another. Look for continued growth and coverage of CP services. It’s a cost effective use of multi-faceted resources. I expect to see more coverage by Medicaid programs – slowly, in bits and pieces – but coverage, nonetheless. There will also be avenues for payment beyond Medicaid (commercial payers, home health, etc.). Progress will be slow, but it will continue.

NEMT is growing. Study after study has shown that getting people to needed services and managing healthcare issues (diabetes, COPD, drug addiction treatment, etc.) improves life quality and decreases costs. Payer/provider relationships will grow.  Whether contracting with a transport broker or working with Medicaid managed care, opportunities will expand for coverage. The go-to for NEMT info of all kinds is NEMTAC which works to develop standards and promote best practices in NEMT.

Rural EMS struggles are sadly mushrooming. Our rural areas are medical deserts where EMS is not only the first-stop, it may be the only option people have. If a rural provider, check the Rural Health Info Hub for support, funding ideas and information.

Money must stop getting lost. Providers’ margins are too tight and expenses high. It is imperative that billing departments and billing companies focus on timely follow-up. Devote resources to this function. Accounts receivable grow at an unmanageable rate and money gets forgotten, or, horror of horrors, must be written off. In our experience, resources tend to focus on claims production. Appeals, denials and follow-up need equal attention.

Self-pay balances will not go away. Regardless of where Washington finally falls on surprise medical billing, there will always be some balances that must be pursued from patients in the form of deductibles and co-payments. Technology has evolved and will keep doing so. Investigate pay-by-text and other software options that could help.

Recoupment requests will continue – even when organizations don’t necessarily owe the money. Medicare contractors have been aggressive in their recoupment efforts regarding trips in/out of nursing homes. Appeal when appropriate. Recoupments are not going away; don’t lose the opportunity to challenge the recoupment.

Medicaid compliance oversight will increase. In FY 2018, Medicaid Fraud Control Units did 18,975 total investigations, resulting in 1,796 indictments and recoveries of $859,172,372. Do an internal review to ensure you follow Medicaid regulations as closely as Medicare. Also remember that Medicaid managed care claims can be subject to review.

 

Medicare managed care enrollment has tripled. In 2006, it was 11% of Medicare population. Today, 34% of Medicare population in managed care. Slightly different rules at play here. Non-emergencies not guaranteed to be paid. Learn the rules and play by them, particularly when appealing claims.

Software continues to evolve offering a broad range of services.  Use evolving technology to manage the patient CP experience by interacting with other healthcare providers in real time. Tackle self-pay early with technology. If you haven’t had a demo or talked to your software companies recently, do so. Visit new and different software vendors and technologies at conferences and utilize resources like LinkedIn where software offerings are constantly updated.

Finally, how requests for service get managed is critical to well-being and financial security. If you have not done so by now, review this topic. Emergency services need good dispatch protocols. Those dispatch protocols must be shared with billing companies and billing departments. Whenever possible, rural providers also need to address dispatch protocols (a much tougher challenge in those rural counties). Non-emergency services need to review their call centers. Better management of the service request will drive the ability to bill and get paid. This is a pressure point for providers.

2019 was wonderful. The staff of EMS Financial Services and I thank you for the privilege of working with you this year. Our best wishes for a happy holiday season and a good new year! We can’t wait to see where our adventures take us next.

About the author:  Maggie Adams is the president of EMS Financial Services, with over 25 years’ experience 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 provide auditing services, assess their billing for best practices and support their billing 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