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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 cost of billing fraud

The cost of billing fraud

ABS Inc. are going to run a series of blogs starting this week to highlight the importance of getting your billing right – first time, every time. Businesses like ABS Inc specialize in billing services and are in the best position to help you avoid the pit-falls they lay in wait.

Millions of EMS journeys are billed to health insurance companies and Medicare every year across the United States. For larger organizations they are likely employ specialized staff to undertake the work, however for smaller organizations where perhaps a minimal number of staff may be assigned billing duties as not much more than an additional duty to their routine.

In either case, the requirements are exactly the same. Billing is to be in accordance with strict requirements from a number of different agencies with Medicare being the most notable of them. If an organization fails to process their EMS claims, in accordance to the regulations, they become open to the possibility of fraud charges, significant penalty payments and even reimbursement of monies collected.

Healthcare is the currently the federal budgets largest expenditure. The huge number of claims submitted every year by an equally huge number of providers means the field of healthcare is wide open for fraud. It is estimated that the annual cost, due to healthcare fraud, to the United States government is in excess of $100bn! With the size of healthcare expenditure and estimated fraud figures, the United States government is ramping up their investigations in to fraud, looking at all types of providers.

In recent times, it was announced by the Justice Department that Columbia/HCA, the hospital giant, agreed to pay a fine of $745 million for systematically defrauding, over a period of several years, the Medicare program. Although it is not believed likely that an ambulance provider or fire department would be penalized to such a significant extent, it does indicate the government is getting serious in their drive to investigate fraud and eliminating it.

Next week, ABS Inc will highlight the common errors made by billing staff and you then begin to understand better why ABS Inc. are the sensible choice to undertake your EMS billing duties. Contact us to discuss any issues you may have and see what we have to offer to help you avoid breaching any of the many regulations in place today..