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[BillingSpecialist]

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

 

[BillingSpecialist]

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.

 

[medicdan]

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?

 

[BillingSpecialist]

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?

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!!

 

[Tigger]

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?

 

[chaz90]

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.

 

[medicdan]

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!!

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

 

[BillingSpecialist]

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!

 

[BillingSpecialist]

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

You're Welcome!

 

[PotatoMedic]

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?

 

[JPINFV]

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?

 

[chaz90]

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.

 

[BillingSpecialist]

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.

 

[BillingSpecialist]

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.

 

[chaz90]

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.

 

[BillingSpecialist]

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.

 

[chaz90]

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.

 

[JPINFV]

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.

 

[Aidey]

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.

 

[BillingSpecialist]

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!