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Medicare coverage of Ambulance Services

Medicare coverage of Ambulance Services aims to be consistent but requires some degree of interpretation and judgement to determine what claim should be submitted for ambulance billing purposes. Medical insurance (Medicare Part B) will cover an ambulance service from or to a hospital, a skilled nursing facility or critical access hospital but only when any other form of transport may endanger a patient’s health.

However, there are cases when Medicare may cover the services of an ambulance under the following circumstances:

  • If a patient needs to transport from their home or medical facility for health care for a condition where transportation by ambulance is required.
  • If a patient requires dialysis, or an end-stage renal disease, and requires ambulance transport to or from a dialysis facility, in the event that any other form of transport is likely to endanger the patient’s health.

Under the Medicare coverage of Ambulance Services guidelines, Medicare will only cover an ambulance service to an appropriate medical facility that is closest to the patient and can provide the necessary treatment and care. If a patient decides they wish to use a facility further away, the Medicare payment is based on the normal charge to the facility that was closest.

In cases where the care that is required is not available in the local area, transport to the closest facility that can offer the required care outside the local area will be covered by Medicare.

Medicare coverage of Ambulance Services may provide cover for an emergency ambulance transport, in the cases where the condition places a serious threat to the patient’s life. Such cases may include unconsciousness, in shock, bleeding or in severe pain. The bottom line is just how serious a patient’s condition is at the time and if an alternative method of transportation was considered more appropriate.

Computer Viruses and System Maintenance

Computer viruses and system maintenance have to be an obvious consideration for any business as any business can suffer from the consequences from an attack on their local computer or servers and each business needs to determine the best and most cost effective solution to provide 24/7 protection from the vandals that distribute these harmful emails and files.

Companies such as MacAfee and Norton offer a range of packages that are renewable annually and on the whole are pretty good at preventing “known” viruses and malware from accessing the system but they also throw up a couple of other issues that are cannot always be considered helpful to other applications that you may use from day to day and can, for the average user, not be straight forward to reconfigure to allow the system to function properly. Employing a dedicated IT employee (or two, allowing for holidays, sickness and other unforeseen eventualities) to maintain computers or a network is an expensive solution but for a business that is accountable to the likes of Medicare, is essential so as to ensure the data is not corrupted and submitted claims will be accepted and correct.

In the case of ambulance and fire departments there is a better solution that will take care of both your ambulance billing services and fully protect the data so that all claims made are accurate. Businesses such as ABS Inc. have dedicated servers with equally dedicated network staff that are responsible for the maintenance of the servers and individual computers that are operatives use, and the cost to you is then significantly reduced for both aspects – ambulance billing and network maintenance.

If it is a risk you are prepared to continue taking then that is of course your choice but why not contact us and discuss what we can provide you with and how much time, effort and cost we can save you. 

Viral Damage

Viral Damage

So what exactly do viruses do to a computer system or network? It depends on the aims of the person that has spread the virus in the first instance but we are going to focus mainly on the viruses that effectively cripple a Windows operating system.

Once the virus has found it’s way in to the operating system, the signs are sometimes immediate but on occasions it may take several days, or even weeks, to become apparent. The bulk of the damage that is likely to be done is in the computers registry files where your  configuration settings and system options are stored in a hierarchical database. A virus may be intended to corrupt one or more of these files and even in cases where just one file is initially corrupted, the impact on other files can be severe and can easily render the system as inoperable as programs fail to either open, close, store newly added data etc. Backing up data on to an external drive (CD or Memory Stick) will help keep your data stored and the actual data is unlikely to be affected, in most cases, but the program itself may not function correctly. In years gone by this was not a serious issues as prior to the launch of Windows Vista, formatting the computer hard drive was a relatively easy process and you could eliminate all traces of all viruses and malware but alas this is not the case with Windows Vista and beyond.

This now presents two choices.

1. You can replace the entire hard drive and/or system and re-install your saved data.

2. Hire the services of someone that knows how to format the systems hard drive.

These two option cost time and money and the knock on effect is that you could be without your computer for several days and the ambulance billing data needs to be logged somewhere and this in turn can cause issues and result in inadvertent false claims to Medicare at a later date once the system is restored.

Common forms of computer viruses

Common forms of computer viruses

Ambulance Billing Services is going to expand on last weeks blog and delve in to the common types of virus on your desktop or laptop computer where you store all your ambulance billing data.

In most cases a virus or malware appears as an exe file (Executable file) and typically remain harmless until activated. Again in many cases these exe. files appear when performing downloads from the Internet from an unknown source but there are “computer hackers” that are a little more cunning in their approach and can disguise the exe. file as another type of file, for example a JPEG, or PNG format. These of course appear to be totally harmless on the surface and if a friend or colleague was to send you this type of file by email you probably would not think twice about opening it.

Email with tempting links are especially nasty as they can take you to a specific website that will automatically infect your system. While it is easy to teach a user to not click on such links, or even open an email from an unknown source, humans are curious creatures and if the temptation is great enough they may just have a look. Managers and Fire Chiefs are likely to hand out disciplinary action, short of dismissal, to the member of staff for activating a virus on the system but this does not solve the problem and it is virtually impossible to stop them from repeating the action unless they are not permitted access to your computer system or network. The person replacing them may be just as curious in the future and so it goes on, while your business is paying out money to either resolve the problem or replace the system and hoping that the billing data is “clean”.

Next week Ambulance Billing Services will explain the potential consequences of a virus on your system or network.

 

 

Computer Security Risks

Computer Security Risks

As ambulance billing is conducted on computer software, the typical ambulance and fire department is now home to a handful of laptop or desktop computers and most are likely to be connected to the internet for as long as the computer is on. Of course a lot of managers and fire chiefs have in place a number of rules and/or regulations regarding Internet use by employees on the working premises and rightly so, but these are not normally put in place for security reason, they normally arise to prevent users spending time online instead of fulfilling their employment terms and conditions.  This is perfectly normal behavior from the employer but it does not prevent the risk of Malware and viruses entering an individual computer or network, where an internal network exists.

Computer viruses have existed for nearly as long as computers have and for whatever reason there are people in the world who just love to create havoc with other peoples computer systems and there are many famous instances over the years to demonstrate that the bigger the network they can hack, the more news worthy it is and the bigger the ego becomes.  Why then, would they bother disrupting an ambulance or fire department? The answer is they do not typically select a specific target in their day to day activities, more a scatter-gun approach that harms and disrupts as many computer systems as possible.

How do ambulance and fire departments combat this? The worrying answer is that most do not and tend to rely on the user to adopt some common sense when using internet sites. Providing the end user knows what to look out for and can identify a potential threat then this may be enough but in most cases it is not enough of a preventative measure, a measure that could ultimately cost thousands of dollars. ABS Inc. is going to expand on this subject next week, highlighting what happens when a virus strikes and what the potential knock-on effects are.

Health Provision and Insurance

Health Provision and Insurance

As covered by ABS Inc last week, the United Kingdom has a very different approach to health care for the masses with an all inclusive service that is free at the point of delivery although private health care has been introduced and has a place in the health system overall. The NHS is at full stretch every year with resources and budgets despite every working man and woman making monthly tax contributions to pay for the service, whether they use it or not. This gives you some idea of the costs involved in maintaining a high level of health care to a countries citizens.

In the United States, a National Health system has not been embraced in full but we does have a system where citizens are subsidized to a greater or lesser extent, depending on their personal circumstances but this does not cover the Ambulance and Fire Services. These businesses need to take care of their own incoming finances for patient collection and delivery to hospitals these services do not come cheap to provide but of course many people do not or will not take this in to consideration yet there is an easy answer in the form of medical insurance.

For a relatively small sum, less than UK tax payer contributions, full medical insurance can be obtained that will include transport, an insurance that perhaps Ambulance and Fire services should promote to the full as in the long run the Ambulance Billing is made easier of a patient is fully covered. Chasing unpaid transportation bills is an expensive business and one of the reasons ambulance billing services are outsourced to third party companies such as ABS Inc. Companies that know how the system works and how to recover outstanding debts, with a very high degree of success.

Contact ABS Inc to discuss how we can help you and what options are available to make your ambulance or fire service more profitable and efficient.

Staff shortages creates errors

Staff shortages creates errors

In February this year, a set of circumstances arose to highlight another, if somewhat unusual issue that can be created without effective communication between Ambulance staff and the Ambulance Billing team and highlights potential flaws in businesses that are “closed loops” with third party Ambulance Billing Services such as ABS Inc.

On 1st January 2013 a man was experiencing difficulties with his breathing and a 911 call was raised at 1.25am and a fire truck appeared on the scene within 9 minutes but unfortunately there was no ambulance available for an immediate response. The ambulance eventually arrived at the man’s home at 1.58am, some 33 minutes after the 911 call.

Between the time of the initial 911 call and the arrival of the ambulance the man sadly died despite help from the attending fire service that was on hand. The timing of the arrival however is not the issue that is the subject of this article, the subsequent bill for Ambulance Services amounting to $780 that was sent to the man’s address and received by the dead man’s son and the circumstances that led to the bill being issued in the first place.

It transpires that the districts Ambulance Service was staffed at abnormally low levels on the night of the death and in excess of 50 firefighters off work due to sickness. Such low levels will of course place a strain on any system that is in place and this was clearly the case in this instance. However, the billing was avoidable with sufficient numbers of competent ABS billing team members.

Such occurrences are embarrassing and damaging to the image of a business and they can be avoided by employing the services of experts in the field of Ambulance Billing. ABS Inc do not suffer with low staffing levels and provide the expertise, knowledge and efficiency to get your Ambulance Billing correct first time, every time.

Contact us today to see how ABS Inc can improve your Ambulance Billing.

How to Prevent Ambulance Billing Fraud Charges

How to Prevent Ambulance Billing Fraud Charges

Happy New Year from ABS Inc. to all our readers and we hope the festive season was a peaceful one for you and your families.

Moving back to the subject matter of previous weeks then…….Last time we looked at the errors created by utilizing “default” responses to the questions regarding transport and services offered to patients and how they can impact your business in two very different ways, both that ultimately cost your business in terms of cash.

How can you avoid the pitfalls of using “default” answers?

There are two options that can help to minimize the risk:-

  1. Do not use “default” answers – while this will slow the process down it should reduce the risk of an incorrect answer providing the operator is competent.
  2. Training – As in any walk of life, it takes practice. In the business world it costs money to teach an employee effectively but even when fully trained, as they are human beings, remain prone to errors if there is a lapse in concentration for any reason, if placed under pressure to complete the task too quickly from their immediate superiors for example.

Note careful that I use the term “minimize” or “reduce” when discussing the risks and not “eradicate” or “remove”. There is an inherent risk, regardless of what you or your operator does.

So the next question is;

How do you remove the risk completely?

There is only one solution that will enable to you remove all risk from your ambulance billing operations, and that is to outsource the activity and pass the risk to an independent body that bear the brunt of any errors made on submissions to Medicare or an Insurance company.

A company, such as ABS Inc. has dedicated and fully trained personnel more than competent to undertake this role, a role we have been performing for many years with a superb success rate. With built in contract clauses that remove risk from your business, it makes financial sense in the long term as we maintain current compliance with all the regulations, another area that can create issues if you or your staff are not up to date.

Contact us today to discuss the options and services we can offer you, to make your billing efficient, cost effective and above all else – profitable.

Inherent Problems of Time Saving Set-ups

Inherent Problems of Time Saving Set-ups

This week ABS Inc. are going to continue the overview of procedural and coding issues faced by Fire Chiefs and EMS services in general, all of which typically lead to investigations, prosecutions and hefty fines.

While many good software programs exist there are others that are not up to the job and cannot assure full compliance to the requirements of Medicare or Insurance companies. The problem comes about when trying to establish settings or default codes in to fields or table tables in the program you are using. They can be time-savers for certain but unless done correctly, will inevitably lead to future issues and cautions needs to be exercised in the billing for the transport provided by ambulance services.

Regulations set out by Medicare show a requirement for answers to a set of questions for each transport, known as an ACR (Ambulance Certification Record). The topics cover are transport type, usage of restraints and condition of the patient when transported, were they in shock or unconscious at the time?

The majority of questions require a simple yes or no answer so departments typically set the defaults to one of these two responses. On the surface that appears to be a reasonable action, so what is the problem here?

If “no” is the default setting it is a good method to avoid fraudulent submission but it can lead to loss of payments for ambulance claims that are valid if the field is not correctly “checked”. Conversely, if “yes” is the default answer, and again the field is incorrectly checked, a fraudulent claim is almost inevitable as you are highly likely to be submitting false claims if the answers do not tally to the patient’s condition.

If you are experiencing any issues with your set up, codes, procedures or ambulance billing contact ABS Inc, we have the answers and solution.

Next week, ABS Inc will conclude this series regarding codes and procedures in the EMS environment, until then have a very merry Christmas.