To manage ambulance billing, it is important to find a specialised team that understands complete revenue cycle management that includes optimised medical coding, proper and timely claims submission with expert handling of accounts receivable and better denial management.

An insurance claim is a collection of data that we transported this patient (patient demographics) on this day (DOS encounter data). They had this issue (coding), we did this for them (coding), and they have this insurance (insurance data).

Get those five pieces of data right, and you will get paid or get any of them wrong or miss any information and getting paid is nothing short of a challenge. To help prevent EMS medical claims processing challenges like getting wrong information or not securing what you need.

Managing ambulance medical claims processing can be an extremely complex task these best practices will help. Here are six important best practices to follow:

Best Practice #1 Understand the differences between appeals and corrected claims.

When ambulance claims are denied billers may either appeal the claim or submit a corrected claim to seek reimbursement for the services rendered. In order, to ensure proper reimbursement, every biller managing denials should understand the difference between the two, and they must follow state and payer guidelines for submitting both.

⇒ When appealing a claim, you are advising the insurance payer that the codes billed are correct, and you are providing further documentation showing that the codes are reimbursable as billed.

For an appealed claim, you must supply documentation to support your appeal. Make sure to include the patient care record/narrative, any relevant amendments, the invoice, your official letter of appeal and a copy of the original claim. There are state-specific guidelines that can be used as well as payer-specific appeal processes.

⇒ When filing a corrected claim, you are advising the insurance payer that you would like to amend items like the CPT, ICD-10 and/or HCPCS codes originally billed. Knowing the difference between these codes is important so that the claim is re-processed correctly and promptly.

The appropriate changes should be made to the CPT, ICD-10 or HCPCS codes, and the bill type should be changed to reflect a corrected claim. If the bill type is not changed, it could be denied as a duplicate bill. The corrected claim should then be submitted electronically to ensure the quickest reprocessing.

Best Practice #2 – Review rejection reports daily.

Review all electronic claim rejection reports daily in order to determine where in the pathway the claim was rejected.

Reviewing reports will allow billers to determine if the cause for the rejection was in-house, with a clearinghouse, or with a direct payer.

If errors were introduced by the billing staff, billing managers can take steps to improve processes and reduce in-house errors. If errors appear elsewhere along the pathway,billing managers should determine why the claims were rejected then call the clearinghouse or payer to investigate further.

Some of the most common rejections are for invalid insurance ID numbers, missing DOB, invalid diagnosis code, demographic errors, and misspelled names. Many of these can be avoided if you have a quality billing software that allows you to implement safeguards to prevent common billing errors.

Best Practice #3 – Scrub claims for errors before submission.

“Scrubbing” includes spot checking all major payers for compliance issues, diagnosis issues, and other possible coding errors.

If the scrub process is clearly defined, it can greatly improve the chances of having a clean claim which reduces days in accounts receivable and increases your reimbursement.

Another aspect of scrubbing is making sure you’re using the correct codes. Leveraging ambulance claims management technology tools not sticky notes all over your computer will automate your processes and ensure your forms are updated with the ever changing ambulance coding guidelines.

Best Practice #4 – Enforce processes that will  reduce the chances of claim rejections.

You can reduce the chances of claim rejections by implementing processes that reduce the potential of them happening in the first place. To do this, billers must understand the electronic pathway of claim submissions for each payer.

Knowing the pathway of claims can also give billers a better idea of how long claims will take to reach payers. 

Electronic claims are sent to an EDI company and, in some cases, on to several trading partners before the claim reaches the payer. The longer the path the claim takes, the more opportunity for errors.

Billing managers can begin to chart the path by following a claim from the ambulance provider to the provider’s EDI company and then determine if the claim goes directly to the payer or to an additional trading partner. In order to reduce the number of steps in these pathways, seek out EDI companies that have direct contracting agreements with most, if not all, of your EMS agencies primary payers.

Best Practice #5 – Implement an integrated EMS workflow.

Revenue cycle management works best when all systems and departments are thoroughly integrated. However, many EMS billing departments, dispatch offices, and patient care departments remain in their own silos working independently.

A five-star claims management solution can provide reports and analysis capabilities to help you uncover hidden causes of issues and engage departments all along the revenue cycle for a cleaner, more transparent workflow.

Our EMS workflow ties departments (dispatch, ePCR, and billing), reporting, and analysis together seamlessly. Because our software is cloud-based and capable of fully integrating all vital departments, it avoids the most common rejections for electronic claims and it’s always up-to-date on the constantly changing requirements of your payer mix, state requirements, and changing reimbursement methods.

Best Practice #5 – Consistently monitor the status of claims.

An EMS biller may do a great job of getting claims out of the door but may fail to monitor the status of claims once submitted.

If the EMS provider doesn’t have a documented process as to how and when to follow-up on pending bills, collection odds will decrease and labor required to clean up accounts receivable will increase.

The bottom line is always monitor the status of claims until they’re closed.

Are you ready to talk about your Ambulance medical claims processing challenges and how we can help, or are you interested in a free demo? Start here.

When you run an ambulance billing service, you need income to drive your organisation. In order to concentrate on your organisation and see that it is the best in its field, your crucial component to help you is your billing area.

If you have a strong, dedicated and knowledgeable staff then you are good at meeting your goals. However, if you have outsourced your Ambulance billing service.

Here are the few things you should know what to expect to meet your high standards and also avoid fraud.

Do they advance in technology?

For your billing and data entry, conforming to the National EMS Information System and being HISPCs compliant is very essential. Your billing system should work in tandem with the NEMSIS. Thus your outsourced billing service should be using the latest and updated billing system for ambulance providers.

Documentation & Support

With the new ICD-10 coding system coming into play, documentation is a crucial factor in the billing system to generate the revenue required. The coders and billers may be certified, but they need to work in an integrated manner with your staff that will provide the “run sheets” that has all incidences documented from when they pick the patient to when they drop the patient. To be able to deliver insurance and payment support to your patients, your billing service needs to complement your work on patient transportation and staying complaint with all healthcare & CMS regulations and requirements and any denial claims should be followed up with the supportive documentation and closely monitor of accounts receivables should be done by them.

Fee Control

Even with the most updated software your outsourced billing service should have the transparency and openness when it comes to fees, especially when you are paying them for increasing your revenues and your monthly statements should be automated to come in at a pre fixed date with all supporting invoices and claims issued. This verifies their in principle integrity and helps keep the business relationship professional and profitable for both.

Setting Quality Assurance Standards

First, maintain a quality assurance by your outsourced ambulance billing service from the initial days insist on tailored reports for your business and introduce how to improve and enhance the billing services.

Secondly, get qualified coders to assess your documents for quality control. When you outsource a medical billing company to handle your billing demands you can check and monitor where the procedures need to be enhanced in-house to help increase your profitability.

Open Lines of Communication

A successful partnership depends on its lines of Communication. In an emergency, all information may not be verified on the spot. When delay in reimbursements of the accounts receivable can be present. As time is crucial to collect the information check eligibility and verification of all the documents which you have submitted.

Control Costs & increase profit

You need to choose wisely when contracting out to an outsourced medical billing company, along with monitoring checks in place. Control your costs, choose wisely from the list of ambulance billing companies, and don’t necessarily settle for the one with the lowest fee. But choose the one that assures you good customer service, with advanced technology and certified coders and billers who are up to date with the healthcare state & federal rules and regulations.

Conclusion

Billing is a key component that helps sustain the efficacy of the ambulance service you provide, So while you concentrate on providing the best service to the patients and healthcare providers, your billing service should be supporting you with the groundwork and timely inputs when required.

If you want further information or need help with your ambulance billing, let us know support@wonderws.com. Good luck!