Got a billing question? Ask Away!

[BillingSpecialist]

Hello all! I haven't been on in awhile and this question thread always does good! If you have any questions let me know and I will do my best to answer them or point you in a direction to hello find your answer! Hope everyone's having a good day!

 

[medic493]

Have you had any struggles, or experience billing for Ials? In other words, services provided by an advanced/intermediate life support?
Also, issues billing for non-transport ems response? PA is now looking to allow 911 agencies to bill for interventions provided which did not result in transport, such as a bolus of dextrose given to a hypoglycemic patient who then refused hospital transport.

 

[wanderingmedic]

Can agencies bill for non-transports (refusals of care, lift assists only, etc.) when a medic unit responds but does not take the patient to the hospital? Additionally, if a paramedic assesses the patient and determines that the pt can be transported BLS, can the service bill for an ALS assessment even if the paramedic does not ride in back with the patient - but instead has his/her EMT-B partner provide care?

 

[BillingSpecialist]

Have you had any struggles, or experience billing for Ials? In other words, services provided by an advanced/intermediate life support?
Also, issues billing for non-transport ems response? PA is now looking to allow 911 agencies to bill for interventions provided which did not result in transport, such as a bolus of dextrose given to a hypoglycemic patient who then refused hospital transport.

We have had no struggle billing for ALS transports, those are actually the easiest ones to get paid. As they are usually the easiest to prove medical necessity for. For the calls that do not result in a transport, they are often difficult to get the patient to pay. I have several clients that bill for them and several that do not. When there's medication administered or something like an assist from the floor, the patients usually pay those fairly well. The ones I've seen having trouble to pay are the ones that were involved in an MVA. The call often comes in from someone passing by, they call the accident in on their cell phone and crew automatically respond, and it's usually not something the patient requested. So it just depends on what was done at the MVA if the no-transport fee is billed to the patient.

 

[BillingSpecialist]

Can agencies bill for non-transports (refusals of care, lift assists only, etc.) when a medic unit responds but does not take the patient to the hospital? Additionally, if a paramedic assesses the patient and determines that the pt can be transported BLS, can the service bill for an ALS assessment even if the paramedic does not ride in back with the patient - but instead has his/her EMT-B partner provide care?

Yes, the non-transports can be billed but there is some difficulty in getting them paid at times. Please see my response in the above reply for details on that.

If the paramedic assesses the patient and determines the call to be a BLS run, it can usually be billed as an ALS run even though BLS was the way the patient was transported. It can be billed as long as the protocol for the dispatch reason would've qualified for a medic to respond. For example.....the call comes in as a patient with chest pain, ALS responds. Upon arrival tot he patient you find that the patient was not at all experiencing chest pain that they had only stubbed their toe. Of course after the medic assesses the patient, he determines that it is a BLS transport. That run can be billed as an ALS run, but the documentation on the run must clearly state that an ALS assessment was completed. You just can't have a medic assessment on call that a medic wouldn't be necessary for. For example....if that call had come in as big toe pain, the protocol doesn't qualify for a medic to be on that call. So you couldn't just have the medic assess the patient in order to bill it ALS instead of BLS.

 

[zzyzx]

What percentage of say, a $1000 ALS transport bill does Medicaid usually reimburse? How much would say, Kaiser insurance reimburse for the same transport?

How do you think the proposed massive cuts in Medicaid (with the repeal of Obama Care) will affect private ambulance companies?

 

[BillingSpecialist]

What percentage of say, a $1000 ALS transport bill does Medicaid usually reimburse? How much would say, Kaiser insurance reimburse for the same transport?

How do you think the proposed massive cuts in Medicaid (with the repeal of Obama Care) will affect private ambulance companies?

Every state Medicaid reimburses differently. So I'd have to know what state you were asking about to give you a for sure answer. But I am from WV, so I will give you an example from those rates. For an ALS trip, the pay $377.50 for loading and $3.80 per mile transported. A private insurance will definitely reimburse MUCH higher than that, those rates of course are different for each one, and usually rates increase for them on a yearly basis. Medicaid on the other hand, rarely raises their rates. I know the Medicaid in WV hasn't increased their rates in 20+ years.

I believe the massive cuts proposed for Medicaid will drastically hurt private ambulance companies, of course depending on the ratio of Medicaid patients transported compared to other insurances carriers. I feel any cuts in medical coverage, for any carrier will drastically effect any private ambulance companies.

 

[EpiEMS]

Medicaid on the other hand, rarely raises their rates.

Any idea what Medicare reimburses?

 

[BillingSpecialist]

Any idea what Medicare reimburses?

Medicare rates depend on the state that you are in as well, but usually differ very little. Here's a link that you can use to find those rates for your carrier.

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AmbulanceFeeSchedule/afspuf.html

 

[BillingSpecialist]

Any idea what Medicare reimburses?

I also just noticed on the link above, for 2017, they only give you the carrier code & not the actual state So If you let me know what state you are looking for I can give you the carrier code.

 

[EpiEMS]

I also just noticed on the link above, for 2017, they only give you the carrier code & not the actual state So If you let me know what state you are looking for I can give you the carrier code.

That's ok! Thanks. Just having the resource to poke around in is great!

 

[DrParasite]

The ones I've seen having trouble to pay are the ones that were involved in an MVA. The call often comes in from someone passing by, they call the accident in on their cell phone and crew automatically respond, and it's usually not something the patient requested. So it just depends on what was done at the MVA if the no-transport fee is billed to the patient.

Just for clarification, are you referring to the insurance company getting a bill, the patient receiving a bill, and if you do bill the patient for a service that they didn't request, do you send them to collections if they don't pay?

I would imagine if you send them a bill for services they didn't request of need, the burden is on them to prove that the bill isn't warranted or justified.

 

[BillingSpecialist]

Just for clarification, are you referring to the insurance company getting a bill, the patient receiving a bill, and if you do bill the patient for a service that they didn't request, do you send them to collections if they don't pay?

I would imagine if you send them a bill for services they didn't request of need, the burden is on them to prove that the bill isn't warranted or justified.

I'm referring to the patient receiving the bill. The insurance will not pay for it, sometimes an auto insurance will pay the no transport fee but very rarely. And yes, it can usually be verified by the CAD Report. And also yes, if the bill is not paid it will go to collections. If the patient didn't request the service and calls to dispute the bill, once it is confirmed that the patient didn't request the services, we then write off the bill.

 

[BillingSpecialist]

That's ok! Thanks. Just having the resource to poke around in is great!

No problem! If you need anything else just let me know!

Have a Great Weekend!!

 

[NomadicMedic]

Is there any rule with Medicare and Medicaid that two sets of vital signs need to be taken on a patient contact to make the PCR valid for billing?

 

[BillingSpecialist]

Is there any rule with Medicare and Medicaid that two sets of vital signs need to be taken on a patient contact to make the PCR valid for billing?

No, I don't know of a "rule" per say, but vitals can play an important role in the billing process. For example if your patient has shortness of breath, for elevated or low BP.....those would be great things to include in the billing out of the claim.

 

[BillingSpecialist]

Good Afternoon Everyone!!
Anyone have any questions?!

Hope your week is going well!

 

[zzyzx]

Thanks for offering your expertise on this forum. For nearly all of us paramedics, how billing works is a mystery. Hope you stick around for a while!

Can you give examples of poor documentation that would result in Medicare or Medicaid not reimbursing a transport or treatments?

 

[SpecialK]

How much gets charged? Do you have an agreement with the Govt that you must only charge a specified amount so you are given a level of public funding in return for not increasing fees? What percentage of funding is public vs user fees? Is this set at the state level presumably?

For example; the ambulance part charge down in my part of the world is fixed at $98 and cannot be raised beyond, for example, 1% or something because this has been agreed to in return for increased bulk funding from the Ministry of Health. The bulk funding is approximately $70 million which is about half of costs but a large increase has been negotiated with the Ministry of Health between now and about 2022.

What happens if the patient doesn't pay or cannot pay? In my case, the local aforementioned part charge is written off.

 

[wanderingmedic]

Can you explain how BLS vs ALS Level 1 vs ALS Level 2 is decided for billing?