Health Provision and Insurance

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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.

Health Provision – US versus UK

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Health Provision – US versus UK

This week, ABS Inc  are looking at the difference in two nations regarding the health service that could not be any bigger, and there is always an on-going debate about the United States system of health provision compared to the National Health Service (NHS) that has been provided to the citizens of the United Kingdom following the 2nd World War. The main difference being that UK citizens pay taxes and National Insurance (NI) payments from their salary and receive free health, ambulance, fire and police services. They still have to make a contribution toward prescribed medicines but this is a flat fee and the remainder is subsidized by the NHS.

However, the NHS is not a not a perfect system and funding always features very high on the politicians agenda. Money is always needed to recruit and train more staff or update equipment. Doctor’s surgery’s and hospitals frequently see long delays in the consultation and treatment of patients and as much as the general public in the UK appreciate the NHS, private health care similar to that in the US has surfaced. The system is based on medical insurance payments in advance so the “potential” patient still pays in advance for medical and ambulance services but this is in addition to their tax and NI payments. These people are still fully entitled to NHS services should they choose to but the public sector typically offers better facilities and accommodation with private room for the patient to stay during treatment.

Private health is not especially expensive in the UK but as it is an addition to other taxes many people are either resistant to the idea or feel they cannot afford the additional cost. In the US though, citizens do not have the same excuse for not protecting themselves with medical insurance that becomes necessary for payments, should they be admitted to hospital or require ambulance or fire services.

ABS Inc will continue on this theme next week and look at why people should invest in medical insurance and why the US system could be considered better than the UK’s adopted NHS.

Staff shortages creates errors

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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

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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

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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.

Authorization and Routine Itemized Billing Procedures

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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.

Poor procedures lead to fraud investigations

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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.

Crack the Code

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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

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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

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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.