# Ask Billing Questions Here!



## BillingSpecialist (Feb 21, 2013)

Good Morning!! I'm new to EMTLIFE, but I thought I would open a thread for you to ask your billing questions. I've been in the EMS Billing field for 13 years and I LOVE IT!! I thought I would start this thread to see if there's anything I could help anyone with!

Have a good day!!!


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## ExpatMedic0 (Feb 21, 2013)

Any idea or speculation how the Patient Protection and Affordable Care Act will effect the EMS industry? Especially regarding reimbursement.


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## BillingSpecialist (Feb 21, 2013)

I really believe it has it's ups and downs. I believe we are headed for a government based insurance, similar to how Canada's medical coverage is handled. Instead of having multiple insurance companies to bill, everything will just go to the government. With that being said, I feel the reimbursement rates are going to be low, similar to rate of a state medicaid reimbursement. The only up side I see really, is that all the self pay patient's that you transport, that don't like to pay their bills, that get written off as a bad debt....will no longer occur. But will the reimbursement from that be enough to compensate for the loss by lower reimbursements...I'm not sure!


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## Brandon O (Feb 21, 2013)

Obviously all insurers are different, but there's a big common gorilla: Medicare. Can you give a quick rundown as to how Medicare generally pays out for different types of ambulance transports?


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## BillingSpecialist (Feb 21, 2013)

For Massachusetts....Medicare pays $7.09-$10.74 for Mileage, $243.51 BLS, $389.62 BLS Emerg, $462.68 ALS Emerg, $292.22 ALS Non-emerg, $669.66 ALS2, $791.42 SCT

Rates may fluctuate a little depending on rural & urban areas


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## Brandon O (Feb 21, 2013)

So they vary by state? That's news to me.

The common wisdom is that they'll always pay for trips to an ED (no matter what the complaint), but with all other transfers, they'll look for reasons the patient didn't need an ambulance. True? If so, what "reasons" are good and which aren't?


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## Achilles (Feb 21, 2013)

Has almsot nothing to do with health care, but is AARP a scam?
Why or why not?


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## Aidey (Feb 21, 2013)

Brandon Oto said:


> So they vary by state? That's news to me.
> 
> *The common wisdom is that they'll always pay for trips to an ED (no matter what the complaint),* but with all other transfers, they'll look for reasons the patient didn't need an ambulance. True? If so, what "reasons" are good and which aren't?



I'm positive that isn't true, at least in my state. We get tickets "kicked back" to us by both Medicare and Medicaid because they are refusing to pay. They get reviewed to make sure there isn't a simple error (like a missing signature) and corrected if necessary.  A while ago I was talking with my boss about it, and asked what tickets I had kicked back recently. A couple of them were for absolutely BS home to ED transports, like "I think I have a sinus infection because I keep sneezing".


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## BillingSpecialist (Feb 21, 2013)

Brandon Oto said:


> So they vary by state? That's news to me.
> 
> The common wisdom is that they'll always pay for trips to an ED (no matter what the complaint), but with all other transfers, they'll look for reasons the patient didn't need an ambulance. True? If so, what "reasons" are good and which aren't?



Yes the vary by state. You can go to cms.gov and access the ambulance fee schedule, it has them separated by state.

They won't always pay for a trip to the ER, it really depends on what their complaints are, and how severe. For example, I bill for a squad that has a patient that is a "frequent flyer" who always calls 911 for a nosebleed to the ER, Medicare refuses to pay for those. Medicare's theory is that is still has to be medically necessary (unable to go by private vehicle) in order for them to pay for it.

With other transfers, non-emergency, there are many things that come into play. You need to obtain a medical necessity form from the doctor, the doctor will need to indicate on it why the patient requires to be taken by ambulance. Some "good" reasons are bed ridden, oxygen dependent, severe/moderate pain with movement, obesity, harm to self or others...anything that would be dangerous to their health if transported by private vehicle. Whatever is listed on your medical necessity from the doctor NEEDS to be indicated on your run report/EPCR, the medical necessity is not enough any more.


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## BillingSpecialist (Feb 21, 2013)

Achilles said:


> Has almsot nothing to do with health care, but is AARP a scam?
> Why or why not?



I don't feel AARP is a scam, but it's not the best choice for a secondary. AARP only pays if Medicare pays, if Medicare denies so do they & then the insurer is stuck with a bill for the fullest amount.


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## Brandon O (Feb 22, 2013)

I have heard varying answers on whether "fall risk" and "needs oxygen" are good reasons for BLS transport (versus chair car, for instance). Comments?


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## AlphaButch (Feb 22, 2013)

We teach our providers to ask the important Why? question.

Why are they a fall risk?
Why do they need you to provide them oxygen? My grandpa had oxygen for awhile and he could work it himself. He'd probably curse someone out if they told him that he needed an ambulance.


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## jemt (Feb 22, 2013)

Is it true everything a provider does is an additional cost?

IE Oygen applied,spinal immobilization, IV started, medication given etc etc.


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## BillingSpecialist (Mar 4, 2013)

It depends on who you are billing. Medicare considers the loading code to be "All Inclusive." But others like Auto Insurances will pay for the additional codes.


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## Sublime (Mar 5, 2013)

What is the most common charting mistake made by field providers? Particularly ones that impact billing. 

Thanks


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## BillingSpecialist (Mar 6, 2013)

Sublime said:


> What is the most common charting mistake made by field providers? Particularly ones that impact billing.
> 
> Thanks



The most common charting mistake would have to be not enough documentation. The documentation plays a HUGE role in the billing aspect of things. Now they are getting more strict with it, Medicare is requiring what ever is on the medical necessity (or PCS) HAS to be on the runsheet as well. 

The couple questions that should be asked when documenting a runsheet are:

*What was patient's condition at time of transport?
*What was patient's conditions that made this transport necessary by ambulance v/s a private vehicle?
*Why/what am I transporting this patient for?


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## Achilles (Mar 6, 2013)

Stupid question, but why do we call it billing in EMS, as opposed to invoicing.


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## akflightmedic (Mar 6, 2013)

In my business, invoices are pre-sales.

I request goods, I am sent an itemized invoice with totals.

I then pay the bill later.


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## BillingSpecialist (Mar 6, 2013)

Achilles said:


> Stupid question, but why do we call it billing in EMS, as opposed to invoicing.



I'm not sure! I've always just referred to it as billing.


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## Aidey (Mar 6, 2013)

Is it necessary to have the patient's full past medical history, current medications and allergies listed in the patient care report when doing an interfacility transfer than has a PCS?


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## BillingSpecialist (Mar 6, 2013)

Aidey said:


> Is it necessary to have the patient's full past medical history, current medications and allergies listed in the patient care report when doing an interfacility transfer than has a PCS?



For billing purposes......no not a full medical history. The medical history is important if it pertains to the necessity of the trip. For example, if the patient has a hx of acid refulx, that's not really gonna matter in proving the trip was needed. Current meds aren't really important to a biller, allergies could be. The more information you can provide about everything will make things alot smoother. And just because you have a PCS isn't enough any more. Anything that dr puts on that PCS needs to be documented on your trip report as well.


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## Brandon O (Mar 6, 2013)

... why allergies?

Are broad medical "reasons" like dementia acceptable, or does there need to be clarification of why that diagnosis prevents the person from going by other means?

Any suggestions when nurses shrug and say, "What should I put? We send everybody by ambulance by policy."


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## BillingSpecialist (Mar 6, 2013)

Brandon Oto said:


> ... why allergies?
> 
> Are broad medical "reasons" like dementia acceptable, or does there need to be clarification of why that diagnosis prevents the person from going by other means?
> 
> Any suggestions when nurses shrug and say, "What should I put? We send everybody by ambulance by policy."



Allergies could be used to code diagnosis, it's not common that they could be useful.

It really needs to be clarification of why that diagnosis prevent the person from going by other means. The more specific the better!!

You need to tell the nurse "If you can't think of anything to put on there that determines the patient needs to go by ambulance, then load the patient up in your car & take them to the hospital." LOL!!! I'm not sure I have a good answer for this one. This has to be something they can put on there, some kind of medical history, weakness....something.


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## BeachMedic (Mar 6, 2013)

Do you bill for AMAs? I know some counties are starting too. I think that is ridiculous.


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## BillingSpecialist (Mar 6, 2013)

BeachMedic said:


> Do you bill for AMAs? I know some counties are starting too. I think that is ridiculous.



Yes, I bill for several counties that are billing for the AMAs.


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## Sublime (Mar 6, 2013)

BillingSpecialist said:


> It really needs to be clarification of why that diagnosis prevent the person from going by other means. The more specific the better!!



I feel like my transfer charts are pretty solid. The first 4 lines are always the same thing. Why the patient came to the ER. What the diagnosis was. Where they are being transferred from and to what facility for what reason. And why they require ambulance. 

At least for ALS transfers the reason is is usually obvious, but sometimes I am unsure what to put. BLS transfers become more tricky on what to put because a lot of times they are literally just getting a ride in the back with some vitals taken and that's it. 

Many times I have charted "Pt. requires ambulance transfer due to need for pain management en route secondary to right tibia fracture (or whatever it is that causes pain)." Does pain management count as a legitimate reason for ambulance transfer?


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## BillingSpecialist (Mar 6, 2013)

The ALS calls are usually the easiest, not hard to prove.

Pain management would work, list pain scale (ex: pain 9/10), what kind of pain management (meds), tib/fib fx could also cause unsteady gait or weakness. The BLS calls are harder to determine before hand, almost every one will be handled differently or have different circumstances that apply.


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## Brandon O (Mar 7, 2013)

What measures will you take to receive payment from patients if their insurance denies the claim (or they are uninsured)? To what extent can there be discounts or deals made?


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## Christopher (Mar 7, 2013)

BeachMedic said:


> Do you bill for AMAs? I know some counties are starting too. I think that is ridiculous.



Why is billing for an AMA Treat and Release ridiculous?


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## BeachMedic (Mar 7, 2013)

Christopher said:


> Why is billing for an AMA Treat and Release ridiculous?



Historically, in the areas I've worked we had never billed for AMAs. Now it is something that I heard has started within the last month.

So maybe i'm just not used to it. Multiple situations have come up where a Pt did not activate the 911 system and due to a technicality that Pt is now receiving a bill. Something I do not agree with. Also, I do not agree with a Pt's family receiving a bill if we work a cardiac arrest and leave their loved one on scene.

Also, some of the local Medics are wondering whether or not to have the Fire Department handle all AMAs/refusals then since it is still not in their policy to bill. The fire guys are going to hate doing all the paperwork though.

I'll be the first to admit that this is just how I feel personally about the issue and that I'm not used to this new idea of non-transports receiving bills from us since it had not been done in my area previously.


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## Brandon O (Mar 7, 2013)

BeachMedic said:


> Multiple situations have come up where a Pt did not activate the 911 system and due to a technicality that Pt is now receiving a bill.



Presumably these would generally be outright refusals of care, not "treat-and-release" situations where medication or other care was received (with consent), yet transport was refused.


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## usalsfyre (Mar 7, 2013)

BeachMedic said:


> Historically, in the areas I've worked we had never billed for AMAs. Now it is something that I heard has started within the last month.


Probably will see more and more of this. Reimbursement is tightening all around. 



BeachMedic said:


> So maybe i'm just not used to it. Multiple situations have come up where a Pt did not activate the 911 system and due to a technicality that Pt is now receiving a bill. Something I do not agree with.


I can get behind this...



BeachMedic said:


> Also, I do not agree with a Pt's family receiving a bill if we work a cardiac arrest and leave their loved one on scene.


...but not this? Why would we not, outside of a misplaced sense of nobility? You think a physician doesn't bill for his time and expertise on an unsuccessful resus? The hospital writes off the supplies? A typical resus will use use a couple of hundred dollars in supplies and tie up an hr of truck time (say $100-200/hr operating cost). Why would you not seek reimbursement for that?



BeachMedic said:


> Also, some of the local Medics are wondering whether or not to have the Fire Department handle all AMAs/refusals then since it is still not in their policy to bill. The fire guys are going to hate doing all the paperwork though.


Sure, you can deliberately drive down your service's revenue stream...don't complain about money or equipment though.



BeachMedic said:


> I'll be the first to admit that this is just how I feel personally about the issue and that I'm not used to this new idea of non-transports receiving bills from us since it had not been done in my area previously.


It's a short-sighted view that many in EMS share unfortunately. At the moment medicine is a business in the US. EMS providers need to start realizing this.


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## Aidey (Mar 7, 2013)

Lets keep it to billing questions guys. 


If we are transporting a patient who is normally wheelchair bound, but uses a highly specialized wheelchair and is unable to use a normal wheelchair, is explaining that enough to meet necessity requirements?


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## BillingSpecialist (Mar 7, 2013)

Brandon Oto said:


> What measures will you take to receive payment from patients if their insurance denies the claim (or they are uninsured)? To what extent can there be discounts or deals made?



When I bill for patients who don't have insurance, I will first run them through the state medicaid system to see if they have coverage. Then I will send a form to the patient along with their statement for them to fill out & return to me. If I get no response from that, I will contact the patient. If I can't get a response from the patient, I will call the hospitals or nursing homes they were taken too & see what insurance they have, if any, for the patient. I go to all measures possible to find their insurance. Now if they are MVA's I handle those a little differently, those you have to stay on top of so you don't lose your money. 

You have to make a "faithful attempt" to collect from the patient before you do anything else. There is no standard to follow for a faithful attempt, but you have to be consistent. I personally feel like a faithful attempt would be 3 statements.


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## BillingSpecialist (Mar 7, 2013)

BeachMedic said:


> Historically, in the areas I've worked we had never billed for AMAs. Now it is something that I heard has started within the last month.
> 
> So maybe i'm just not used to it. Multiple situations have come up where a Pt did not activate the 911 system and due to a technicality that Pt is now receiving a bill. Something I do not agree with. Also, I do not agree with a Pt's family receiving a bill if we work a cardiac arrest and leave their loved one on scene.
> 
> ...



Some of the companies that I bill for will only bill for a non-transport if they've done some kind of work on the patient. A lot of the time, these non-transport billings are established for the people who take advantage of the ambulance, like the lady who calls all the time for help up from her chair, or the guy who calls just to get free meds....you all have those kinds of people.


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## Brandon O (Mar 7, 2013)

BillingSpecialist said:


> You have to make a "faithful attempt" to collect from the patient before you do anything else. There is no standard to follow for a faithful attempt, but you have to be consistent.



What does "anything else" amount to? Going to collections? Lawsuits?

If there is actually no insurance, is the straight cash rate discounted at all?


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## BillingSpecialist (Mar 7, 2013)

You're absolutely right on the cardiac arrest patients. I know it stinks for the loved ones, but it's a billable service. It's billable to Medicare (just the loading, no mileage) & if there's no Medicare & the patient has an estate, you can have it applied to the estate.


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## BillingSpecialist (Mar 7, 2013)

"Anything else" refers to collections, lawsuits, write offs of any kind. 

Nothing should be discounted until a "faithful attempt" is made. There should be some kind of policy in place for handling those accounts that you get no response on. It should also be standard....for all patients.


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## BillingSpecialist (Mar 7, 2013)

Aidey said:


> Lets keep it to billing questions guys.
> 
> 
> If we are transporting a patient who is normally wheelchair bound, but uses a highly specialized wheelchair and is unable to use a normal wheelchair, is explaining that enough to meet necessity requirements?



Those are tricky transports. If you have enough detail in your explanation & can get a doctor to sign off on a medical necessity (PCS), you should be okay.


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## Scott33 (Mar 7, 2013)

BillingSpecialist said:


> "Anything else" refers to collections, lawsuits, write offs of any kind.
> 
> Nothing should be discounted until a "faithful attempt" is made. There should be some kind of policy in place for handling those accounts that you get no response on. It should also be standard....for all patients.



How do you collect from foreign nationals who are visiting the US, but end up using EMS services? Particularly those who neglect to take out travel insurance (not mandatory for travel to the US).


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## BillingSpecialist (Mar 7, 2013)

Scott33 said:


> How do you collect from foreign nationals who are visiting the US, but end up using EMS services? Particularly those who neglect to take out travel insurance (not mandatory for travel to the US).



These are the worst! There isn't a whole lot you can do with them. Because is would be very costly to go after them for their bill. There are collection agencies who claim they can collect on these foreign accounts, but I have yet to find one who actually collects anything! Unfortunately.....situations like these will more than likely result in a bad debt write off!


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## Aprz (Mar 8, 2013)

I live in the San Francisco Bay Area, California. I was taught the "10 presumptive criteria for medicare".

Unconscious or shock
Emergency (ie car accident)
Restraints
Immobilized or c-spine
Hemorrhage
Bed bound*
Oxygen
Stetcher
Stroke
Respiratory or cardiac

*bed bound by itself wasn't a good enough reason by itself

And these were reasons that could be used to bill medicare for "why should they go by ambulance".

Companies require a copy of the patient's psychiatric hold (eg 5150) or advance directives (eg DNR) attached to the PCR. The original stays with the patient.

My question is if a patient is on a psychatric hold, but you felt they did not require restraints and you did not transport them with restraints on, is that still billable as BLS? What if your company has policy requiring that the patient be transported with restraints, but both you and the sending physician/RN felt the patient doesn't require it? In addition to this question, what about patient's that require an ambulance for special position or using some sort of wedge (eg bed ulcers, post hip replacement requiring a wedge, post total knee replacement). Supposedly no special position for the patient with an ulcer, and both the hip replacement requiring a wedge or total knee replacement patient want to walk to the gurney and the sending physician/RN says it's OK for them to do it. Does that still get billed as BLS?

Is a DNR a criterion for "why should they go by ambulance"?

If so, are there are things that are like this that are listed in the "10 presumptive criteria for medicare"?

What about people who pretty much require rapid transport to a facility (eg dissecting aneurysm), could you document the reason as "rapid transport" as a reason for why they should go by ambulance?

Thank you.


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## BillingSpecialist (Mar 8, 2013)

No, a DNR alone would not fit the criteria for a reason to be transported by ambulance. Just because you have a DNR doesn't meant that it would be unsafe to the pt's condition to go by other means. I would really depend upon what else was going on with the pt. And yes, they should've know that if the pt has a DNR then you should obtain a copy of it. The pt is goig to be in your truck, and could crash, having that DNR is very important!

The 5150, yes that would qualify a pt transport. The 5150 was issued because someone felt the patient was of harm to them-self or to others. Of course it would require documentation on the EMTs part as to what's going on with the pt. With or without restraints shouldn't deem it "unbillable," the patient can be a harm to themself or to others & not necessarily "need" to be restrained. If your company has a policy in place that a pt w/a 5150 requires restraints, then I'm afraid you would have to do it. Maybe suggest to them that it be revised to state "unless EMT and/or physician feel it wasn't necessary." 

For the special position/wedge placement transports, if the pt is being wheeled in a wheelchair to the gurney & then walking from the chair to the gurney, that should be ok. You could document that one like "pt being transported s/p total hip replacement. able to walk from w/c to gurney with assistance but no able to stand for long periods. must be transported laying down with wedge placement on side" Document it well & obtain a good medical necessity from the doctor!

The "rapid transport" reason is not a very good reason alone. The thing to remember is to document well! The trip will be considered medically necessary as long as the pt cannot go to a facility by other means without it being harmful to their health. If going by other means would be harmful to their health, then you need to document those reasons.

Here's a link to the Transportation manual from CMS http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/bp102c10.pdf Maybe it will help you.


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## BillingSpecialist (Mar 16, 2013)

Any body got any questions? This threads been kind of quiet for awhile.


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## Brandon O (Mar 17, 2013)

Which insurances, or in what situations, will automatically pay for round trips (to appointments etc)? Versus requiring separately medical necessity statements each way?


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## DrParasite (Mar 18, 2013)

BillingSpecialist said:


> They won't always pay for a trip to the ER, it really depends on what their complaints are, and how severe. For example, I bill for a squad that has a patient that is a "frequent flyer" who always calls 911 for a nosebleed to the ER, Medicare refuses to pay for those. Medicare's theory is that is still has to be medically necessary (unable to go by private vehicle) in order for them to pay for it.


so then what happens?  does the agency have to just take it as a loss, should they keep billing the guy, knowing he is going to ignore the bill?  Can they refuse transport because it's not "medically necessary"?  what about calls such as a kid with a fever, who EMS will take in the ambulance, while the family follows behind, will insurance kick it back?

I know in NJ, we CAN'T refuse transport, EVER.  if you have a hangnail, and want to go to the ER, the ambulance WILL take you.



BillingSpecialist said:


> It depends on who you are billing. Medicare considers the loading code to be "All Inclusive." But others like Auto Insurances will pay for the additional codes.


so do i need to put on the PCR that i used 4 pairs of gloves, linen, tape, 3 4x4s, tape, reusable straps vs triangular bandages?  does it matter how much me get paid, or does it all fall under the whole "all inclusive?"





BillingSpecialist said:


> like the lady who calls all the time for help up from her chair,


can you charge insurance for lift assists, or just send a bill to the patients?


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## RocketMedic (Mar 18, 2013)

Does a ticket have to be signed by the patient to be billable?


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## BillingSpecialist (Mar 22, 2013)

Brandon Oto said:


> Which insurances, or in what situations, will automatically pay for round trips (to appointments etc)? Versus requiring separately medical necessity statements each way?


I wouldn't suggest billing any of them without a medical necessity per trip. Usually the only insurances that will let you combined them on one claim & bill them is a Medicaid or Workers Comp, but even them are on a per insurance basis. It all depends on what each insurance wants.


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## BillingSpecialist (Mar 22, 2013)

DrParasite said:


> so then what happens?  does the agency have to just take it as a loss, should they keep billing the guy, knowing he is going to ignore the bill?  Can they refuse transport because it's not "medically necessary"?  what about calls such as a kid with a fever, who EMS will take in the ambulance, while the family follows behind, will insurance kick it back?
> 
> I know in NJ, we CAN'T refuse transport, EVER.  if you have a hangnail, and want to go to the ER, the ambulance WILL take you.
> 
> so do i need to put on the PCR that i used 4 pairs of gloves, linen, tape, 3 4x4s, tape, reusable straps vs triangular bandages?  does it matter how much me get paid, or does it all fall under the whole "all inclusive?"can you charge insurance for lift assists, or just send a bill to the patients?



No you cannot "refuse" a transport for it not being medically necessary. If the patient calls, states it's an emergency & needs to go to the hospital, you can't refuse them. If it's a schedule transport, you could refuse that, you could even require them pay upfront before you transport them. If you bill the patient and they don't respond to the bill, or know they are just going to ignore the bill, the squad yes will more than likely have to take that as a loss. I would suggest still sending them onto a collection agancy, and maybe one day if they decide to be a responsible adult & attempt to buy a home or something they'll have to pay your first. It may never happen, but you aren't out anything by doing it.

With the child with the fever....it just depends on the documentation..how high was the fever, were there any other problems, does the pt have an extensive medical hx? The insurance may kick it back for "just a fever" you would have to bill it and see, alot of it depends on what kind of insurance they have too.

If you are going to bill for anything additional then yes, you need to document it. There is a code for BLS Disposable supplies, ALS Disposable supplies, that most of those thing would fall under, you can bill for pulse ox, ekg, iv, extra emt, defib, intubation. The insurance you are billing determines on whether you can bill the codes out or they are considered " all inclusive."  Medicare will not take extra codes or most Medicaids, but most of your commercial insurances will, and definitely auto insurances.

Your lift assists can not be billed to the insurance, you would have to bill the patient's for those directly.


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## BillingSpecialist (Mar 22, 2013)

Rocketmedic40 said:


> Does a ticket have to be signed by the patient to be billable?


Yes, the patient should sign off on the billing authorization before you bill it out.


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## Milla3P (Mar 25, 2013)

I know that routine transports require Medical Necessity (PCS) forms. But are these forms required for EVERY trip for a regular?

I was told a long time ago that a PCS is valid and applicable for a pt who is being transported for a regular routine reason (ie: dialysis) for 60 days. 

Is that true, close to true or was I lied to for years?


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## JPINFV (Mar 25, 2013)

Milla3P said:


> I know that routine transports require Medical Necessity (PCS) forms. But are these forms required for EVERY trip for a regular?
> 
> I was told a long time ago that a PCS is valid and applicable for a pt who is being transported for a regular routine reason (ie: dialysis) for 60 days.
> 
> Is that true, close to true or was I lied to for years?



I don't remember the time limit, but yes. If it's something like dialysis 3 times a week (plus return), then they need one on file, not a new one every trip. If the dialysis patient, say, skips a session, ends up in the ED with fluid/electrolyte issues, and then is discharged, the discharge will need it's own PCS.


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## Milla3P (Mar 25, 2013)

JPINFV said:


> I don't remember the time limit, but yes. If it's something like dialysis 3 times a week (plus return), then they need one on file, not a new one every trip. If the dialysis patient, say, skips a session, ends up in the ED with fluid/electrolyte issues, and then is discharged, the discharge will need it's own PCS.



What about repeated ED discharges for identical Dx? (repeated falls) just something that I've run into recently.


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## BillingSpecialist (Mar 26, 2013)

Yes, the medical necessity is good for 60 days for a routine trip, like dialysis or wound care or something like that. But for routine ER visits, discharges, no you can not use the same medical necessity the same way as you do for a schedule re-current trip. For every ER discharge, you will need a different medical necessity. And it is also correct that if you take that dialysis patient to the ER & then they are discharged, you can not use the dialysis medical necessity, you will have to get the dr to sign off on one that is different, specified for the discharge.


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## Brandon O (Mar 26, 2013)

BillingSpecialist said:


> Yes, the medical necessity is good for 60 days for a routine trip, like dialysis or wound care or something like that. But for routine ER visits, discharges, no you can not use the same medical necessity the same way as you do for a schedule re-current trip. For every ER discharge, you will need a different medical necessity. And it is also correct that if you take that dialysis patient to the ER & then they are discharged, you can not use the dialysis medical necessity, you will have to get the dr to sign off on one that is different, specified for the discharge.



Why is this? I would presume that the question isn't whether the patient needs ambulance transport -- since that's already been vouched for -- but whether they need to go where they're going. But is there really doubt whether, for instance, a person needs to return home from the hospital?


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## JPINFV (Mar 26, 2013)

Brandon Oto said:


> Why is this? I would presume that the question isn't whether the patient needs ambulance transport -- since that's already been vouched for -- but whether they need to go where they're going. But is there really doubt whether, for instance, a person needs to return home from the hospital?





It makes sense superficially to say that this set of routine transports requires an ambulance, and that extra (return) trip isn't one of these routine transports. 

Anything else, it makes about as much sense as the rule at my current hospital that says that OR scrubs have to be covered when outside the OR. After all, my raggedy [butt] white coat that lives in my trunk when I'm not at the hospital is apparently cleaner than the air in Southern California.


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## Milla3P (Mar 26, 2013)

Is the 60 day renewal some sort of fraud protection proving that that particular person is still alive?

If its not that morbid, then why would a dialysis patient with CRF need to be reupped? Couldn't it be a more indefinite thing?


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## Brandon O (Mar 26, 2013)

Milla3P said:


> Is the 60 day renewal some sort of fraud protection proving that that particular person is still alive?
> 
> If its not that morbid, then why would a dialysis patient with CRF need to be reupped? Couldn't it be a more indefinite thing?


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## WuLabsWuTecH (Mar 27, 2013)

BillingSpecialist said:


> Yes, I bill for several counties that are billing for the AMAs.





Christopher said:


> Why is billing for an AMA Treat and Release ridiculous?





BeachMedic said:


> Historically, in the areas I've worked we had never billed for AMAs. Now it is something that I heard has started within the last month.
> 
> So maybe i'm just not used to it. Multiple situations have come up where a Pt did not activate the 911 system and due to a technicality that Pt is now receiving a bill. Something I do not agree with. Also, I do not agree with a Pt's family receiving a bill if we work a cardiac arrest and leave their loved one on scene.
> 
> ...



This is why we do not bill for responses.  We roll up to a car accident that's a fender bender and neither party called us.  Why should they pay for a service that they did not want?  And actually, if we roll up to a car accident and there's no one that want's help, it's technically a no patient found, and no one needs to sign for anything...



usalsfyre said:


> Probably will see more and more of this. Reimbursement is tightening all around.
> 
> 
> I can get behind this...
> ...



We do not bill for unsuccessful cardiac arrests that we call on scene for our residents as a courtesy.  It's our policy to write these off.  We think it's a PR issue and that since we do not need the revenue of $50 (our residential billing rate)from that run to make our budget, there is no reason we can't, as human beings, decide to let that $50 go.


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## WuLabsWuTecH (Mar 27, 2013)

Question for the OP on differential billing.

At my rural department, we have different rates for residents vs. non-residents.  The terms are well defined (as someone who lives, works, or goes to school in the district).  We bill $50 for residents and I think somewhere along the lines of $700 for non-residents.  Additionally, we do not bill for runs into a specific township because that township contracts with our department, and they pay something like $1500 per run for each run we take in their township (so the agreement says we do not bill the patient).  This has been going on for years.

But at my second department, we recently started talking about billing since the majority of our runs (60ish%) are now mutual aid into a city that bills our residents when they come mutual aid into our town.  Because we have so few residents in our town and township, the majority of our runs are mutual aid.  Someone mentioned that it would be illegal to bill differentially which is what is preventing us from starting billing.  We would like to bill as our expenses are now at the point that we cannot sustain our annual budget on the levy alone, but we're only slightly over budget and don't want to bill the residents of the town (and our contract with the township that pays us $x per year says we can't bill them).  The budget gap is such that billing mutual aid runs would more than make up for the gap, but someone said this is illegal?  True?  False?  False but based in truth that was misinterpreted?


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## BillingSpecialist (Apr 23, 2013)

WuLabsWuTecH said:


> Question for the OP on differential billing.
> 
> At my rural department, we have different rates for residents vs. non-residents.  The terms are well defined (as someone who lives, works, or goes to school in the district).  We bill $50 for residents and I think somewhere along the lines of $700 for non-residents.  Additionally, we do not bill for runs into a specific township because that township contracts with our department, and they pay something like $1500 per run for each run we take in their township (so the agreement says we do not bill the patient).  This has been going on for years.
> 
> But at my second department, we recently started talking about billing since the majority of our runs (60ish%) are now mutual aid into a city that bills our residents when they come mutual aid into our town.  Because we have so few residents in our town and township, the majority of our runs are mutual aid.  Someone mentioned that it would be illegal to bill differentially which is what is preventing us from starting billing.  We would like to bill as our expenses are now at the point that we cannot sustain our annual budget on the levy alone, but we're only slightly over budget and don't want to bill the residents of the town (and our contract with the township that pays us $x per year says we can't bill them).  The budget gap is such that billing mutual aid runs would more than make up for the gap, but someone said this is illegal?  True?  False?  False but based in truth that was misinterpreted?


Sorry it's taken me a while to respond! I've been super swamped!

With situations like these....you have to show that you "attempted" to collect payment from everyone. I have squads that I bill for that have these same kind of procedures they follow. You would have to determine a time frame for your "attempt" to collect, I would suggest at least 2 statements. The trick being....the statements "Get Lost" on their way to the mail box


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## BillingSpecialist (Apr 23, 2013)

Milla3P said:


> Is the 60 day renewal some sort of fraud protection proving that that particular person is still alive?
> 
> If its not that morbid, then why would a dialysis patient with CRF need to be reupped? Couldn't it be a more indefinite thing?


The 60 day renewal is a form of a "Re-Evaluation" by the doctor. Medicare, for instance, just wants to make sure patient's condition hasn't changed. A valid up-to-date medical necessity is required by Medicare for any non-emergency trips, recurrent ones or individual ones.

I know it's frustrating to have to stay on top of the reoccurring schedule trips, but it determines the payment of your claims. You may get the claim paid, but if Medicare requests the Medical Necessity and you don't have it, they will take their money back.


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## medicdan (Apr 23, 2013)

Another question, or few. I think I understand the idea of a standized billing schedule, that is, a lump payment based on the acuity of the call, with adjustments for mileage, rural areas, etc, but can you specify what's required for some of these levels of care?

Is there only one BLS code, and does that include all BLS interventions, including LSB, splinting, etc. What about "BLS" meds, like epi, Asa, etc. What about services that are doing BLS naloxone, albuterol nebs, etc? Do all of these get the same block billing as BLS? Is there a different reimbursement for emergencies vs transfers? 

When looking at ALS, is there a different rate for ILS as Paramedic level care? Can a "Paramedic level assessment" be billed differently? Is ALS1 just iv, saline and 4 lead monitoring? What interventions make it ALS2? 

How about transfers, what's the difference between ALS, SCT and CCT re: interventions? Are there other cost modifiers?


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## BillingSpecialist (Apr 23, 2013)

emt.dan said:


> Another question, or few. I think I understand the idea of a standized billing schedule, that is, a lump payment based on the acuity of the call, with adjustments for mileage, rural areas, etc, but can you specify what's required for some of these levels of care?
> 
> Is there only one BLS code, and does that include all BLS interventions, including LSB, splinting, etc. What about "BLS" meds, like epi, Asa, etc. What about services that are doing BLS naloxone, albuterol nebs, etc? Do all of these get the same block billing as BLS? Is there a different reimbursement for emergencies vs transfers?
> 
> ...


http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R130BP.pdf

The above link will describe you to what each means & what are the qualifying factors for each. Hope that it's helpful to you!

There is a BLS Non-Emergency code A0428 & a BLS Emergency code A0429. There is one set pay scale for each code.

Here's a link to CMS where you can access the fee schedule: 
http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AmbulanceFeeSchedule/afspuf.html

Hope all of this information is helpful to your questions. If you have any more please just let me know!

Have a good day!!


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## Tigger (Apr 23, 2013)

I work in a rural area, and there are literally dozens of ways to get to the larger hospitals in the cities since the city is a grid with a convoluted series of major 4 lane roads that run in awkward angles through the grid.

I was recently told that my way to one hospital is not acceptable because it is "too long" and that it puts the service at risk for the patient to complain to their insurance/Medicare that we intentionally go the long way to get more money out of them. 

How does this work exactly? My way is a mile longer than the "preferred way," how does billing feel about this and can patients file a grievance over this?


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## chaz90 (Apr 23, 2013)

Tigger said:


> I work in a rural area, and there are literally dozens of ways to get to the larger hospitals in the cities since the city is a grid with a convoluted series of major 4 lane roads that run in awkward angles through the grid.
> 
> I was recently told that my way to one hospital is not acceptable because it is "too long" and that it puts the service at risk for the patient to complain to their insurance/Medicare that we intentionally go the long way to get more money out of them.
> 
> How does this work exactly? My way is a mile longer than the "preferred way," how does billing feel about this and can patients file a grievance over this?



Why not just bill for the shortest distance route and eat the extra mile? I admit I know absolutely nothing about billing, so this could be completely wrong or illegal.


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## medicdan (Apr 23, 2013)

BillingSpecialist said:


> http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R130BP.pdf
> 
> The above link will describe you to what each means & what are the qualifying factors for each. Hope that it's helpful to you!
> 
> ...



Thank you very much, I'll pour through the AFS.


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## BillingSpecialist (Apr 23, 2013)

Tigger said:


> I work in a rural area, and there are literally dozens of ways to get to the larger hospitals in the cities since the city is a grid with a convoluted series of major 4 lane roads that run in awkward angles through the grid.
> 
> I was recently told that my way to one hospital is not acceptable because it is "too long" and that it puts the service at risk for the patient to complain to their insurance/Medicare that we intentionally go the long way to get more money out of them.
> 
> How does this work exactly? My way is a mile longer than the "preferred way," how does billing feel about this and can patients file a grievance over this?


One mile is okay. If it were several miles out of the way I could see a problem. You are supposed to go the shortest way possible. Not only for the sake of the patient's insurance but for the safety of the patient as well.

I wouldn't be concerned with one mile though!


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## BillingSpecialist (Apr 23, 2013)

emt.dan said:


> Thank you very much, I'll pour through the AFS.


You're Welcome!


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## PotatoMedic (Apr 23, 2013)

Here is a question.  That may or man not have been answered so sorry if it has.  Quickest way vs shortest?  if it is in the pt's best interest to get their the fastest but it adds 2-3 miles (but cuts off about 10 minutes) is that acceptable?


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## JPINFV (Apr 23, 2013)

chaz90 said:


> Why not just bill for the shortest distance route and eat the extra mile? I admit I know absolutely nothing about billing, so this could be completely wrong or illegal.


On the other hand, when I was working we used the vehicle trip meter to document transport distance. If I took a longer route (e.g. construction), I wouldn't necessarily know the extra distance that it took.

Also, why would you eat an extra mile if you didn't have to? Would you be ready to say that if the money for that mile came out of your pocket directly instead of your company's pocket?


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## chaz90 (Apr 23, 2013)

How about using GPS distance for every transport, thereby charging every pt. for the theoretical shortest distance? This would remove any room for people to complain of unfair distance billing. If you needed to go a different route for time, traffic, or whatever it would be fine, but the mileage could remain as short as possible.


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## BillingSpecialist (May 7, 2013)

FireWA1 said:


> Here is a question.  That may or man not have been answered so sorry if it has.  Quickest way vs shortest?  if it is in the pt's best interest to get their the fastest but it adds 2-3 miles (but cuts off about 10 minutes) is that acceptable?


It's usually the shortest way, least amount of miles, since insurance companies pay per mile. But I would also say that if pt is in critical care & an emergency situation, the additional 2-3 miles but 10 minutes faster....could be appealed & get paid. But I also want to state that those kinds of appeals would have to be on emergency trips to get paid.


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## BillingSpecialist (May 7, 2013)

chaz90 said:


> How about using GPS distance for every transport, thereby charging every pt. for the theoretical shortest distance? This would remove any room for people to complain of unfair distance billing. If you needed to go a different route for time, traffic, or whatever it would be fine, but the mileage could remain as short as possible.


You could do that, but you chance losing money by doing it that way. There would be circumstances that you could get reimbursed for those additional miles.
And people complaining...LOL!! How long you been in this field?  There's nothing you could do to make all happy, you could charge them no miles & they would still complain.


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## chaz90 (May 7, 2013)

I know it wouldn't eliminate all complaints by any means, but it would take away any justifiable complaints regarding mileage charges. I realize the agency could lose out on some money for mileage, but my impression was that most money comes from the base charge. Also, losing one or two miles on a 30 mile transport doesn't seem like a huge deal to me.


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## BillingSpecialist (May 7, 2013)

chaz90 said:


> I know it wouldn't eliminate all complaints by any means, but it would take away any justifiable complaints regarding mileage charges. I realize the agency could lose out on some money for mileage, but my impression was that most money comes from the base charge. Also, losing one or two miles on a 30 mile transport doesn't seem like a huge deal to me.


Money comes from the base rate & the mileage as well. You would lose alot of money per run, but it would add up. If you do 2500 runs a year, and you miss out on 2 miles per run....it will add up quick over a course of time.


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## chaz90 (May 7, 2013)

BillingSpecialist said:


> Money comes from the base rate & the mileage as well. You would lose alot of money per run, but it would add up. If you do 2500 runs a year, and you miss out on 2 miles per run....it will add up quick over a course of time.



But should that mileage really be charged in the beginning? If there is a shorter route available, I would say the patient should be charged for that shorter distance. If the driver needs to go around or take a different route, that's fine, but billing wise it would be better for the patient to take an extra 2 minutes and go the shorter distance.


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## JPINFV (May 7, 2013)

chaz90 said:


> But should that mileage really be charged in the beginning? If there is a shorter route available, I would say the patient should be charged for that shorter distance. If the driver needs to go around or take a different route, that's fine, but billing wise it would be better for the patient to take an extra 2 minutes and go the shorter distance.




Do taxis and other vehicle for hires work like this? Faster time/longer distance route gets charged the same as the longer time/shorter distance route? That longer distance still requires fuel and maintenance (since maintenance is more off of distance than engine time).


Want to fix EMS billing issues, tie pay directly to reimbursement. I've seen threads on the SDN EM forum about how to bill for a pulse ox interpretation. That extra few dollars that some insurances pay (since not all insurances pay for it) goes a long way when it goes directly to your pocket.


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## Aidey (May 7, 2013)

chaz90 said:


> But should that mileage really be charged in the beginning? If there is a shorter route available, I would say the patient should be charged for that shorter distance. If the driver needs to go around or take a different route, that's fine, but billing wise it would be better for the patient to take an extra 2 minutes and go the shorter distance.



I would say it depends on the situation. If the shorter route has 5 unguarded train crossings, or goes over a drawbridge, or has major road construction, you might be looking at a 15-20 minute difference in transport time.


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## BillingSpecialist (May 7, 2013)

JPINFV said:


> Do taxis and other vehicle for hires work like this? Faster time/longer distance route gets charged the same as the longer time/shorter distance route? That longer distance still requires fuel and maintenance (since maintenance is more off of distance than engine time).
> 
> 
> Want to fix EMS billing issues, tie pay directly to reimbursement. I've seen threads on the SDN EM forum about how to bill for a pulse ox interpretation. That extra few dollars that some insurances pay (since not all insurances pay for it) goes a long way when it goes directly to your pocket.


I have to agree.....if there's something you can bill for and get paid...Do It! Whether it's one tenth of a mile or 2 mile or anything else..IV, OX, Pulse Ox, Extra Attendant, Waiting Time. Not all insurances will pay for it, but there are some that will. Especially in calls related to auto accidents...they will pay for just about anything and at 100%. Most squads need every last cent they can get, let nothing that you do go unbilled if it's billable!


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## Brandon O (May 7, 2013)

Speaking of which, which insurances will pay for additional personnel or other extras for bariatric patients? Or for waiting time on a wait-and-return transfer?

Also: will some insurers refuse to pay, or partially pay, for a longer emergency transport if a patient requested it? Stable patient, we bypass a nearer hospital because they wanted to go elsewhere?


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## BillingSpecialist (May 7, 2013)

Brandon Oto said:


> Speaking of which, which insurances will pay for additional personnel or other extras for bariatric patients? Or for waiting time on a wait-and-return transfer?
> 
> Also: will some insurers refuse to pay, or partially pay, for a longer emergency transport if a patient requested it? Stable patient, we bypass a nearer hospital because they wanted to go elsewhere?


Medicare and most state Medicaid's (including the HMO Plans) will not pay for the extra stuff. Alot of private insurances will pay for some of them, like Blue Cross, Aetna, Cigna, United Healthcare. Then all your auto policies will cover them, as long a pt has med pay. It's really a trial & error or some investigation on the carrier

Insurance carriers will partially pay for the the long trips, that are at the patient's request. I have seen some of them get paid, but they were fully paid because the patient filed the appeal.


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## Aidey (May 7, 2013)

But Medicare/Medicaid generally do not pay for the extended trips, correct?


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## BillingSpecialist (May 7, 2013)

Aidey said:


> But Medicare/Medicaid generally do not pay for the extended trips, correct?


Correct


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## JPINFV (May 7, 2013)

...and here's an interesting question. Since you can't balance bill medicare/caid, would that be sufficient reason to refuse a request to a further facility? Alternatively, does Medicare/caid allow balanced billing of uncovered benefits?


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## BillingSpecialist (May 23, 2013)

When a patient is requesting to go to a further facility, you need to let them know that the insurance will not cover the trip if they do not go to the closest facility, then you make them sing off on it (like an ABN). They sign off excepting responsibility for the trip that they were informed would not be covered.

Medicare will allow you to balance bill for what's not covered, but each Medicaid is different as they are a state by state carrier. You would have to check with your state Medicaid on that to be sure.


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## Brandon O (May 23, 2013)

Can you remark on any ongoing and planned changes to reimbursement as part of the Affordable Care Act?


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## BillingSpecialist (May 23, 2013)

I don't believe there are any planned changes to reimbursement at this time. But I do believe there will be. With this ACA, all people will eventually have health insurance. I believe that there will be a decrease seen in your revenue, eventually! 

There is a penalty that employers will have to pay if they do not offer healthcare to their employees, but in most cases that penalty is far much less than the premiums they have to pay. Therefore....employers will pay the penalty and force the employees to take the "Government" Insurance, which will more than like have reimbursements along the same lines as your state Medicaid reimbursements. 

So the people who don't have insurance currently, will finally have something to pay their bills, but the other dropping to the "Government" Insurance will decrease your income.

But.....these are my personal thoughts and opinions


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## BillingSpecialist (Jul 8, 2013)

Good Morning All!!

Just wondering if anyone has any questions!?

Hope everyone had a good 4th of July Holiday and that everyone has a good week!


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## Sandog (Jul 8, 2013)

How can you reduce the insurance rates on the ambulance fleet. The rates are killing us.


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## Aprz (Jul 9, 2013)

Does having a copy of the patient's driver license, passport, or other identification help with billing? Does having a copy of their insurance card help with billing?

I want to push the DNR thing because I am perplexed by something I see in the field. I was taught at my previous company to get a copy of the DNR to attach to my PCR. I was taught by current company to do the same. I am wondering why is a copy of the DNR useful? I thought it had something to do with billing.

Is there a website with a list of reason they should be transported by ambulance? I don't feel like the 10 presumptive medicare criteria cover it. Like we were just talking in the chatroom how supervision is a reason they should go by ambulance, like if the patient has dementia or Alzheimer's disease, and they are being discharged to a skilled nursing facility, wouldn't putting "requires ambulance because require supervision, history of dementia and Alzheimer's disease, oriented only to person" for example be good enough reason to transport by ambulance?

I noticed that CMS means Center for Medicare & Medicaid Services. I was never taught to get a Physician Certification Statement (PCS) for Medicaid. Does Medicaid have the same rules as Medicare?

Is there any information that's useful to include that helps with getting reimbursement from other insurances eg Blue Shield that isn't required by Medicare?

If I didn't say it already, thank you for answering our billing questions. I feel like billing is a very important part of the care report that people often don't care about, and leave out, and I feel some of it is pretty complicated.


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## BillingSpecialist (Aug 20, 2013)

First I want to apologize for just now getting back to you. I didn't see the notification come in that someone had posted something, and I just happened to hop on and check on it.

Having a copy of a patient's driver's license or passport, would help with the verification of the spelling of a patient's name or making sure you have the correct mailing address. A copy of the insurance card is VERY helpful in billing, there are times that you are asked to send a copy of the insurance card along with a claim. As we know though, these documents are not always available, but when they are, I strongly encourage you getting them.

A DNR is always a good document to have just due to the type of work you do in this field. That way you cover yourself. For example, you transport a patient and you don't resuscitate them, the family throws a fit (because they didn't know they patient had a DNR), you have the documentation to back yourself up. As for needing it for billing, no I don't see it necessary. All my years in billing and I've never seen a need for it in the billing aspect.

I don't know of an actual website that would list out those reasons. The term "Medically Necessary" is defined differently by each individual. When reading a run I always put myself in that patient's position "If I was this patient with a nose bleed would I REALLY need to go by ambulance?" "If I were this patient who is 90 years old & has been vomiting & diarrhea for 48 hours would I REALLY need to go by ambulance?" If I answer "Yes" then I have to pull together to documentation to prove that it was Medially Necessary to the insurance company, who ever they may be. Medicare guidelines are always good to go by, as many insurances follow Medicare guidelines as well, but if you go a little off of those, as long as you've got good documentation to prove your right you should be okay. And even if you are submitting all the correct diagnosis, narrative, and additional documentation, you may still get a denial (which does happen from time to time), but if you feel confident that it was indeed Medically Necessary...don't give up on it...appeal appeal appeal!

I would get into the habit of getting a PCS for EVERY NON-EMERGENCY trip you take, no matter what the insurance is. Those non-emergency transports are the ones that will most likely get denied, and that is ALWAYS an excellent document to have on file! Medicaid's differ state by state, you will have to get on your state's Medicaid site and look up their requirements. Those state Medicaid's can be a pain in the butt and they're usually not worth any of it...cause most of them don't reimburse for crap!

The keys to billing are to diagnosis as much as possible (ICD9 Codes), always include a narrative (with information that you aren't able to get an ICD9 code for, exoss MI, list out equipment used or medications administered, ex: EKG, IV, Nitro), make sure your crew is documenting everything. I know they hate it, but it's got to be done. It's a waterfall effect....if they aren't documenting correctly, then the company is getting paid, which is in turn going to result in them not getting paid! Something else that you need to consider in billing private/commercial insurances like BCBS, Cigna, Aetna, Auto Insurances, Worker's Comp...ect, is that there are things that Medicare considers "Bundled" that you aren't aloud to bill them for, you can bill the private/commercial insurance for. Examples, BLS Disp Supplies, ALS Disp Supplies, IV, Oxygen, Pulse Ox, C-Collar...ect.

And you are VERY welcome for the answers to the billing questions. You are correct that billing is very important & can be very complicated. I started this thread because I thought it would be a good place for people to come ask a question and get an answer or suggestions. And the thread has turned out to be much more of a success than I thought it would be  I may not know all the answers, but with enough information, I can find it or direct you to where to start. And if I don't know, I'm not afraid to say so. Thank you for the opportunity! If you need some more help, please let me know!


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## BillingSpecialist (Aug 20, 2013)

http://screencast.com/t/91FmsKbJo

That was supposed to say:

Ex: Poss MI

Guess I didn't put the proper spacing & it created a face..LOL!! Sorry about that!


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## Aprz (Aug 21, 2013)

Thanks for replying and taking the time to do this!  I tried doing a lot of research on this and stumbled upon ICD9 codes and other codes. Found information on ICD9 at http://www.icd9data.com/2012/Volume1/default.htm, and found a lot of information at https://www.novitas-solutions.com/index.html. Thought it was interesting. If I come up with anymore questions, I'll be sure to post 'em here. Might be awhile for me though, lol.


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## unleashedfury (Aug 21, 2013)

What does one have to do to learn billing? I mean is there a certification or degree requirement? 

I look at it this way, I am not gonna be a youngin forever. and if it means I end up in the back office do admin or billing. I'd be ok with that. That and I am a information guru I love to learn new things so learning the billing aspect of my job would be cool


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## Aprz (Oct 12, 2013)

Not sure if you're still around. I don't really mind if anyone answers this.

I was wondering if the patient's social security number, height, and weight is at all useful for billing? If so, how so?


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## CodeBru1984 (Oct 12, 2013)

Aprz said:


> Not sure if you're still around. I don't really mind if anyone answers this.
> 
> I was wondering if the patient's social security number, height, and weight is at all useful for billing? If so, how so?



I don't usually ask for the patient's social security number when filling out paperwork, as it is normally on the face sheet provided by the hospital.


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## Aprz (Oct 12, 2013)

CodeBru1984 said:


> I don't usually ask for the patient's social security number when filling out paperwork, as it is normally on the face sheet provided by the hospital.


I rarely see it on any of the hospital facesheets here.


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## Sublime (Oct 22, 2013)

Question: Do you know if a patient signing an AMA form has negative effects for them in terms of insurance reimbursement?

For instance, we had a patient who had a seizure contemplate signing our AMA form but instead decided to be transported after saying "Nevermind last time this happened it showed up I went AMA and the insurance wouldn't pay because of it". I am not sure exactly what she meant by that but I am curious if you know anything about it.


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## chaz90 (Oct 22, 2013)

Sublime said:


> Question: Do you know if a patient signing an AMA form has negative effects for them in terms of insurance reimbursement?
> 
> For instance, we had a patient who had a seizure contemplate signing our AMA form but instead decided to be transported after saying "Nevermind last time this happened it showed up I went AMA and the insurance wouldn't pay because of it". I am not sure exactly what she meant by that but I am curious if you know anything about it.



We used to run on a frequent flyer diabetic. My old service charged for "Treat no transport," and his insurance would only pay if we transported. We'd wake him up on scene every time, transport him to the hospital, then transport him back 30 minutes later. The insurance happily paid the $700 transport fee plus the hospital bill rather than the $100 treat no transport fee time after time. I believe that was able to be changed eventually, but it was an absurd cycle for a while.


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## broken stretcher (Oct 23, 2013)

When we get called by PD either to the scene or to their stations for prisoner evals or for 9.41 transports (psych), who pays for this. Like mentioned above, the pt did not activate the 911 system the police officer did.


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## unleashedfury (Oct 23, 2013)

broken stretcher said:


> When we get called by PD either to the scene or to their stations for prisoner evals or for 9.41 transports (psych), who pays for this. Like mentioned above, the pt did not activate the 911 system the police officer did.



I know in my system if we do a eval for the PD who have a prisoner in custody if its a non transport. We do it out of courtesy, being that PD shows up on EMS calls a lot of times to assist us Since our PD requires you to be a certified EMT at minimum to maintain your job they keep a first aid bag and AED with them and help with lifting or problem patients. 

If we transport for psych its billed to the patients insurance, if no insurance I believe they try through the Medicaid (state funded insurance) fund.


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## BillingSpecialist (Mar 11, 2014)

unleashedfury said:


> What does one have to do to learn billing? I mean is there a certification or degree requirement?
> 
> I look at it this way, I am not gonna be a youngin forever. and if it means I end up in the back office do admin or billing. I'd be ok with that. That and I am a information guru I love to learn new things so learning the billing aspect of my job would be cool



There is a really good conference offered by Page, Wolfberg & Wirth. There is a link on their website to take a certified ambulance coder class. There conferences are a little on the pricey side, but they are worth EVERY cent.


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## BillingSpecialist (Mar 11, 2014)

Aprz said:


> Not sure if you're still around. I don't really mind if anyone answers this.
> 
> I was wondering if the patient's social security number, height, and weight is at all useful for billing? If so, how so?



Sorry about the delay. I've been busy caught up in other things & am just now getting around to checking in. 

SS# is important for the billing side, we can do lots of searches with the ss# in regards to their insurance. For example most of the State Medicaids will allow you to search by SS# & Date of Birth to see if there is coverage. We've tracked down alot of insurances with a patient's ss#. Also the ss# is useful if a company decides to send any outstanding accounts to a collection agency. The height and weight are only important if they are related to the transport. Like if you are transporting an obese patient, the weight would be important.


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## UnkiEMT (Mar 11, 2014)

BillingSpecialist said:


> Sorry about the delay. I've been busy caught up in other things & am just now getting around to checking in.
> 
> SS# is important for the billing side, we can do lots of searches with the ss# in regards to their insurance. For example most of the State Medicaids will allow you to search by SS# & Date of Birth to see if there is coverage. We've tracked down alot of insurances with a patient's ss#. Also the ss# is useful if a company decides to send any outstanding accounts to a collection agency. The height and weight are only important if they are related to the transport. Like if you are transporting an obese patient, the weight would be important.



Odd, the word has come down from our biller that we need to have weights listed on our IFT PCS because Medicare is pitching a fit.

I wonder if that's just a matter of always getting one so we don't miss one on the occasion that it's relevant to the reason for transport.


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## 18G (Mar 11, 2014)

Is a Physicians Certification Statement (PCS) required for patients being transported inter-facility from a government VA Hospital? 

I have heard yes because VA benefit recipients can still have medicare and I have also heard that no we don't because both the VA and medicare are government agencies (ie basically the same entity). Surprisingly, conflicting information has come from within my organization. 

Thanks!


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## BillingSpecialist (Mar 12, 2014)

UnkiEMT said:


> Odd, the word has come down from our biller that we need to have weights listed on our IFT PCS because Medicare is pitching a fit.
> 
> I wonder if that's just a matter of always getting one so we don't miss one on the occasion that it's relevant to the reason for transport.




I have not experienced that issue at all. Not saying that it isn't possible, because Medicare always comes out with these odd things they feel need to be done on a transport. Most of my companies are out of West Virginia & Virginia, and it is not effecting us here.

If your billler has requested that the weight be entered, then you better do it...no one wants a mad biller


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## BillingSpecialist (Mar 12, 2014)

18G said:


> Is a Physicians Certification Statement (PCS) required for patients being transported inter-facility from a government VA Hospital?
> 
> I have heard yes because VA benefit recipients can still have medicare and I have also heard that no we don't because both the VA and medicare are government agencies (ie basically the same entity). Surprisingly, conflicting information has come from within my organization.
> 
> Thanks!




A medical necessity should ALWAYS be obtained on an inter-facility or non emergency trip regardless of the insurance. Treat every insurance as though they are Medicare. I've seen several different payers deny if there's no medical necessity on non-emergency trips. 

VA recipients can have Medicare. This line "no we don't because both the VA and medicare are government agencies (ie basically the same entity)," make no sense to me  If they are basically the same entity then why would it be required for Medicare and not the VA.


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## unleashedfury (Mar 12, 2014)

First thanks for the info.. 

Second we have a 3rd party billing service, and I am curious as to a few things. 

1. The Signature release sheet. after transporting a patient we are required to get a signature for a HIPPA release, and billing release which has been industry standard for a while now. I am ok with that.  What has me a bit confused here is since its easier for us to make a scratch sheet/run sheet and the signature sheet the same paper (we have signatures on one side the other side has call related information) Patients name location of dispatch date times vitals etc. Our billing company now wants both sides to be completed in its entirety and attached to the PCR or chart. We were told that this is required for appropriate billing as it shows "medical necessity" 

I was getting a lot of crap over it because I don't use them. These sheets are on legal document paper size 8.5 x 14, and are big bulky and look like crap when your trying to write notes in a moving ambulance. I tend to write all my information in shorthand on a index card or on a ECG strip. I believe if I have to have my hands tied up playing clipboard EMT im not treating my patient. So I would never fill these things out just the signature side and complete my assessment findings/ vital signs and treatment plan in the electronic charting. Now we are required to complete all of it. Is there a reason behind having to write out a chart and hand write a scratch sheet? My previous service had similar sheets with your scratch part on one side and signature sheets on the back. Never complained once that I never wrote them out.


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## BillingSpecialist (Mar 12, 2014)

unleashedfury said:


> First thanks for the info..
> 
> Second we have a 3rd party billing service, and I am curious as to a few things.
> 
> ...




As long as you are getting the patient's signature for the HIPPA release and billing release signed, you should be able to use either. As long as your scratch sheet has the same wording as what's on the back of the run. I bill for several companies that that have created "mock" forms that they use and they all work just fine.

My company offers EMS Charts to all of our clients and they have the ability to have the patients sign directly on their IPad or Tough Book and it attaches itself to the chart. I'm not sure what EPCR system you use, but they may have something similar.


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## unleashedfury (Mar 13, 2014)

BillingSpecialist said:


> As long as you are getting the patient's signature for the HIPPA release and billing release signed, you should be able to use either. As long as your scratch sheet has the same wording as what's on the back of the run. I bill for several companies that that have created "mock" forms that they use and they all work just fine.
> 
> My company offers EMS Charts to all of our clients and they have the ability to have the patients sign directly on their IPad or Tough Book and it attaches itself to the chart. I'm not sure what EPCR system you use, but they may have something similar.



We use EMS Charts.. however my company is too cheap to buy iPads, Laptops or anything to eliminate cutting down trees.


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## BillingSpecialist (Mar 14, 2014)

unleashedfury said:


> We use EMS Charts.. however my company is too cheap to buy iPads, Laptops or anything to eliminate cutting down trees.



LOL!! Well maybe that will change one day!


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