Tag Archive for: medicare regulations

Authorization and Routine Itemized Billing Procedures

Authorization and Routine Itemized Billing Procedures

Having covered the basic issues surrounding procedural errors we are going to have a closer look as to why they are happening and if you recognized any of these issues then ABS Inc. believes you need to contact us and discuss your options.

Authorization signatures

Obtaining authorization appears to be the main issue, with the patient deemed to be in no condition to be able sign the appropriate form by some, and others reluctant to approach the subject as it may seem insensitive under the circumstances. The first scenario is quite feasible in some cases but there can be no excuses to willfully violate Medicare regulations.

There are alternatives methods to obtaining signed authorization.

  • If a parent or legal guardian is present on arrival at hospital, authorization can be sought from them by the transport personnel, although there is no legal obligation for them to sign to form.
  • When send the initial statement, enclose the authorization and once return with a signature, bill the insurance company or Medicare.
  • Request your local hospitals to add the authorization form to their other release and authorization documents.

Routine Billing for services and supplies

Routine itemized billing for services and medical supplies is the next common procedural error. Medicare specifically states only the services and supplies that are actually provided are covered yet it has become apparent that there are still EMS departments that adopt this approach to their billing process, in all probability to make the workload quicker and easier. It is a violation of Medicare regulations to charge for any services and supplies and if you practice routine itemized billing, you will eventually be taken to task by Medicare as they will recognize a pattern when auditing  and a questionable ‘over use’, as far as the claims indicate, of an item or items will act as a red flag.

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.