Hallelujah! Spring is finally here! The arrival of spring brought new EMS field and billing problems to our door. We quickly realized that it’s time for spring cleanup. The question is, who’s doing the cleanup at your organization? From what I hear, many of you just can’t find the time to do it. Today, let’s talk about your cleanup chores and how to best tackle them so you continue quality patient care while also getting your oh-so-important reimbursement. We’ll start with the field and move to billing.

Cleaning Up After Field Providers

QA, QA, QA! Before trip reports leave operations there needs to be a QA process. QA review will spot clinical problems (did the crew do all that was needed for the patient?) as well as documentation problems (is it clear why the patient was in an ambulance?).  Operational QA is best done by a trained EMT or paramedic.

Let’s be practical. You probably don’t have the manpower to review every single solitary trip report. Your volume of transports may be too high for total review. But, you can establish a good targeted QA program. Decide on a percentage of trips (depending on your volume). Randomly review those 10% of trips (or whatever number the organization decided upon).

Review trip reports to assure:

·         Times and mileage are documented

·         Dispatch information is noted (particularly important for emergencies)

·         Appropriate clinical information is included

·         Crew signature and certification level noted

·         Patient or representative signature was captured

·         Necessary forms are available (refusal, Physician Certificate Statement, etc.)

QA provides feedback to operational management and field providers; it reinforces quality patient care and underscores the importance of compliant documentation.

Billing Cleanup

So much focus is put on getting claims out the door, that little time is devoted to addressing the claims that come back in the door – through denials. The other problem is that many claims never get paid.  Managing denials and aging accounts receivable (A/R) is an area where concentrated cleaning efforts are needed.

I always ask clients to show me a report of their denials and the aging accounts receivable. Sure enough, there is lots of money stuck in the 90-day and over category. Often, there are significant unpaid claims in the 60-day category as well. When management sees the A/R and denials reports, they usually direct the billing department to work the A/R and clean it up.

What happens next is a flurry of activity directed towards the oldest accounts. It takes much more time and effort to work the oldest accounts. For many of those old accounts, timely filing expired or the trail of the claim is cold (records need to be tracked, payers have to be pursued who may or may not have access to your claims data, etc.). It is much more effective to work the youngest accounts first.

Target denials and claims in the 60 to 90-day category. The information is fresher and more accessible for younger claims. You are less likely to miss timely filing for an appeal. Perhaps the payer never received your original claim and you need to resubmit. Pursuing younger accounts makes it more likely that you will be within the filing limits for payment.

Batch your payers together. If you have a large group of Medicare denials, work them first. Next, look to see who owes you the most. You may have a large balance of unpaid claims at a particular insurer or a facility. Gather them together and tackle the issues with the claims. You may learn that you have an internal problem (improper coding) or you have a problem with a particular payer.

If you see a pattern of problems with a particular payer, consider escalating the issue. If the payer is an insurer, your state department of insurance may have options for you to file a complaint. Another helpful step is to contact your state ambulance association. Your service may not be the only service who is experiencing issues with a certain payer. Joining forces with others in the same boat may lead to better resolution.

Regardless of your approach, routine A/R and denials cleanup is an important component of a successful billing operation.

Compliance Plan Plus Policies

Since it’s spring cleanup time, now is a good time to pull out your dusty policies and your compliance plan for review. Policies and procedures need annual review, but you may not have the time to do it all at once. Instead, set a goal to review of a couple policies a week, or even one policy per week. Once the policy is reviewed and updated to reflect your daily practices, make a note on the calendar to review that policy one year from the date reviewed this year. The result will be that you will not be overwhelmed with too many policy reviews at once and it will be easier to manage going forward. Policy review and updating will become a regular part of your business cycle. It will allow you to be adaptable, flexible and certainly more compliant…and you will have policies that actually reflect your real-life day-to-day business needs.

Let us know if there is anything we can do to 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