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Crack the Code

Crack the Code

Last week ABS Inc. covered the issue of fee schedules and the initial base rate set up for your business, the impact and pitfalls faced by setting it up incorrectly. This week we are covering coding errors.

Insurance companies and Medicare reimburse transportation by ambulance once it has been confirmed the transport was “medically necessary”, based on the condition of the patient when transport was provided and to this end a coding system was been introduced to aid the billing process. Medicare requires claims to be submitted with at least one diagnosis code (ICD Code) as outlined in the International Classification of Disease manual. Since the development of the ICD codes used as the final diagnoses, the use of them in ambulance transport coding is complex at its best, and at its worst, an opportunity for fraudulent claims by departments, knowingly or unknowingly.

Billing staff members require adequate training to be able to interpret run sheets and the correct codes. It can be all too easy to innocently select the incorrect code identifying the patient condition, a code that implies the condition was worse than it was. It is equally possible that billing staff can select a code that is too vague, more often than not just three digits entered for transport justification.

Such coding errors can lead to fines and even the forfeiture of reimbursements. Coding errors are the main reason most fraud investigations take place, and they are avoidable errors! It is also common for insurance auditors and is Medicare practice to review claims to identify possible exaggerations or trends. If they identify something that appears to be questionable, they will follow up and investigate further.

Training individuals sufficiently is both time consuming and expensive and the person providing the education needs to be fully conversant with what they are teaching. This is where companies such as ABS Inc. offer a valuable role in:-

  • Saving you time and money in training costs.
  • Ensuring your base rate is set up correctly.
  • Ensuring the correct codes presented on all claims are correct.
  • Maximizing your reimbursements.
  • Avoiding potential fraud investigations.

Contact ABS Inc. to discuss your needs and find out just how we get offer you the best solution to your EMS billing.

The effects on an incorrect base rate

The effects on an incorrect base rate

Last week ABS Inc. revealed the most common errors made when submitting your billing. This week we are going to cover the fee schedule errors that give cause for concern and frequently lead to emergency services missing out on reimbursements from Medicare, normally caused by the initial set up of the billing regime and processes.

Methods of billing are very common problem area. Medicare carriers require providers to submit bills for the service by one of the available four methods. If you have a fully itemized fee schedule and if your carrier has placed limits, or you opt to bill using the method that permits the mileage and base rate, you are then unable to bill for medications, disposable supplies or any additional itemized charges.

If you had the foresight to establish the base rate that was inclusive of itemized charges, then this should not be an issue. However if your base rate is not inclusive you are not going to maximize your Medicare reimbursement, and any attempt to bill for the additional itemized elements is likely to see you being charged with a violation of Medicare regulations.

Now we will have a look at the issue of inappropriate charges. Medicare’s regulations require ambulance providers to include reusable and routine supplies as part of their base rate. Disposable gloves, linens, backboards etc. are considered to be base rate inclusive by Medicare, and again any attempt to make a separate charge for such items, Medicare regulations are violated.

Issues such as these, if not avoided from the outset, can become quite a serious issue for your business as you face a high probability of violating one or more of the Medicare regulations, and worse still you may be losing money from the day you start simply because you have set the base rate at an inappropriate level.

By employing the services of ABS Inc. these types of issues can be addressed and we can get your business maximizing its return from Medicare. Contact us today, we have the knowledge and experience to transform your billing system and return reimbursements that you are entitled to once the billing system is correctly set-up.

Need to improve your Ambulance Billing Service?

Need to improve your Ambulance Billing Service?

More and more people are becoming increasingly aware of just how much value an EMS Billing Service can offer to their organization.

A recent news article (10th October, 2012) described how city officials in Glenn Heights, Dallas has taken on board an external billing service as they looked for ways to increase revenue without increasing taxes. So why was this decision made?

Quite simply an independent Ambulance Billing Service can provide a better and more efficient service to both their clients and the general public. At ABS Inc. we employ dedicated individuals to perform specific tasks to ensure the smooth running of all operations.

It mostly comes down to the management issue of billing services within the emergency medical services. It can be time consuming and expensive, more so when it comes to debt recovery. There is of course the added burden and cost of keeping up with current policies and regulations from organizations such as HIPAA.

ABS specialists, such as ABS Inc. provide a service that brings everything together and generates growth in revenue, substantial increases in many cases. Any EMS company that is struggling to break even or making small gains in their billing services really need to have serious consideration in to out-sourcing this business activity to a dedicated and expert billing service provider, such as ourselves.

Another aspect that should be considered is the customer service relationship. Our members of staff are trained to deal with all people in a highly professional manner, remaining courteous at all times in dealing with their affairs.

ABS Inc use the industry’s leading ambulance billing software to ensure maximum revenue potential and provide the best possible solutions and service.

Talk to us for an informal discussion on how ABS Inc. can help you realize the revenue potential of your EMS business.

Another joins the fold

Another joins the fold

In February this year the Barren-Metcalfe Emergency Medical Services made the decision to go ahead with outsourcing their ambulance billing on a 12 month contract. The service had been considering the possibility of outsourcing for some time and during their discussions with other Emergency Medical Service providers it became evident that most others had already adopted outsourcing as their way forward for the billing side of the service.

It was also confirmed, in all cases, that there was an immediate increase in monies collected, highlighting that providers such as ABS make a difference. An Emergency Medical Services director stated that the company awarded with the contract would be able to collect enough revenue to offset costs. Certain guarantees formed part of the contract, so no revenue was actually lost by Barren-Metcalfe, as a safety net, though it is firmly believed that they would not need to fall back on such a clause.

The decision to outsource was following the departure of one of their employees about 9 months earlier. The loss of just one employee, for whatever reason indicates the fine balancing act the Emergency Medical Services go through to ensure a smooth and efficient running service in conjunction with employee issues.

Companies like ABS will erase any such concerns so the services can get on with their primary role of attending call outs. This aspect of outsourcing cannot be stressed enough. Human resources can be a costly exercise in both time and finances, remove that burden and it becomes instantly noticeable who much more time and effort can be put in to the activities that “really” matter.

If you are one of the EMS providers that still have in-house billing, contact ABS today to discover what the benefits of outsourcing are, this will be a decision you will not regret as ABS are here to make your life easier and allowing you to free up time to do what you do best.