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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.

Poor procedures lead to fraud investigations

Poor procedures lead to fraud investigations

Having touched on the matter of fee schedules and coding errors, this week ABS Inc. will discuss the procedural errors that also create problems for Emergency Medical Services.

Procedural errors are the most common error for fire departments and are caused mostly due not being familiar with insurance and Medicare regulations with regards to Ambulance transport but as always, Medicare will not accept regulation ignorance as a defense. Medicare also considers information published in the Federal Register, newsletters and carrier billing manuals as adequate billing and charges procedures so the onus is very much on the ambulance services to ensure and up to date copy of their carrier’s manual is in place and further ensure a careful review of the section updates in newsletters.

Fire departments are also somewhat negligent when it comes to submitting claims that are not supported with signature authorization documents, HCFA 1500 & 1491 claim forms. Not only are these claims considered as fraudulent by Medicare and insurance companies, it may also be considered as mail fraud.

If an insurance company or Medicare carrier request a signature authorization form and the fire department cannot produce it, monies made for that claim will almost certainly need to be refunded. If a fire department is audited by a Medicare carrier and it is discovered that it is routine to not provide the forms the carrier is likely to request further investigation at the Office of Inspector General. Medicare has authority to recover monies paid out for each Medicare transport for a period of three years prior to the date of the investigation.

ABS Inc. will continue of the procedural errors next week to highlight further common practices that rebounding on departments create problems, fines and reimbursements that should never have been necessary in the first instance.

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.

Common Billing Errors

In the majority of cases where fraud charges have been filed against emergency medical services and fire departments, the problems are normally traced back to their billing process. Unfortunately in these cases, ignorance of the regulations is not valid in defending a prosecution. In order to avoid the possibility of a fraud investigation, EMS managers need to have a clear and thorough understanding of current regulations. A number of common errors have been identified, these common errors are:-

  • Fee schedules
  • Coding
  • Internal Procedures

Fee schedules – In the case of fire departments, this typically relates to the adoption of the fee schedules and structures set out by ambulance services. Billing methods and inappropriate charges are the most common errors.

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. A code system has been introduced to aid the billing process and Medicare requires claims are 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. Unless billing staff members are sufficiently trained in the interpretation of the information and able to select the correct codes, it becomes possible for an incorrect code to be submitted unwittingly.

Procedural errors – In fire departments, this is the most frequent type of error, typically due to lack of knowledge or understanding of insurance and Medicare regulations with regards to the services of ambulance transport. As far as Medicare are concerned, ignorance is no defense.

Next week ABS Inc. will continue this theme by going a little deeper in to the issues and highlight the importance of their business when it comes to helping you in preventing any potential fraud investigation against your business.

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.