Ask Billing Questions Here!

[BillingSpecialist]

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!!!

 

[ExpatMedic0]

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

 

[BillingSpecialist]

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!

 

[Brandon O]

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?

 

[BillingSpecialist]

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

 

[Brandon O]

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?

 

[Achilles]

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

 

[Aidey]

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".

 

[BillingSpecialist]

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.

 

[BillingSpecialist]

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.

 

[Brandon O]

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

 

[AlphaButch]

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.

 

[jemt]

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

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

 

[BillingSpecialist]

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.

 

[Sublime]

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

Thanks

 

[BillingSpecialist]

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?

 

[Achilles]

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

 

[akflightmedic]

In my business, invoices are pre-sales.

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

I then pay the bill later.

 

[BillingSpecialist]

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.

 

[Aidey]

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?