We could argue that each and every EMS field clinician doesn’t need to be a certified ambulance coder or billing specialist, but on the other side of that coin, each and every field clinician should have some general knowledge of the billing practices of their agency.
In a very general sense, there’s two basic sides to the billing coin: EMS agencies and patients. We (EMS) provide a medical/clinical and transportation service, while they (the patients) receive said service and are expected to pay for it. This is the basic relationship shared between EMS agencies and their patients throughout the majority of systems within our country. Sounds simple ... right?
Well, if it were that simple, how could we possibly have hold-ups, stalls, delays or outright refusals for payment for this valuable emergency service? Let’s break down 10 factors holding up your billing and receiving practices (five on the EMS side of the coin, and five on the patient side), and how to help your agency become more efficient in this process.
1. Missing or incorrect patient information
You ask the patient, “what’s your name, sir?” He replies, “Scott.” That’s pretty simple ... right? “Scott” is name that doesn’t typically have any aliases associated with it – like Bob, Bobby or Robert. So, you enter “Scott” into the first name section of your patient care report (PCR) and move on. This may be the name that the patient answers to, but is it his legal name – the one that shows up on his insurance cards, drivers’ license and social security card?
Ensuring that you’re entering the correct – legal – name of your patient can set the pace for how billing processes may evolve as your agency tries to collect for their services. Confirming this simple question could verify that his legal name is Jonathan Scott, Johnathon Scott or J. Scott for short.
2. Missing signatures or paperwork
Having the patient sign your report does more than “make the red go away;” it attests to their allowance of your care and billing stipulations. Having the patient (whenever possible) sign your PCR is the ideal course of action to complete every report. When this is not possible, then having an authorized representative is an approved alternative.
It’s equally as important to verify that you have an authorized sending provider’s signature documented on your physician care statement (PCS) form as well. Simple holdups like these can cause severe backlogs in your billing practices after the call is complete, and after each of these parties has gone their separate ways.
3. Conflicting information
You respond to a motor vehicle collision for a patient seeking evaluation (a traumatic event), but your drop-down menu options within your PCR indicate the patient’s chief complaint is abdominal pain. This doesn’t make sense! Yes, the seat belt could cause injury, but from a documentation standpoint, it’s important that you think of your drop-down selections and differential diagnosis from the basic standpoint of what caused this.
In this situation, the MVC resulted in the patient’s abdominal pain (unless it really was the other way around; you know, the classic chicken and egg scenario). Conflicting information like this – noticed between your drop-down items, flow chart and narrative – can cause billing back-ups because your billing team is having to dig deeper into what they need to appropriately bill for.
4. Incomplete PCR
The above three factors all add-up to an incomplete PCR. Coupled with legitimately missing or incomplete fields, having too much red in your report begs for too many questions (and certainly does no benefit to your billing cycle).
5. Delayed billing
Backlogs, incomplete reports, insufficient billing staff, missing information and inaccurate data – just to name a few – all can result in denied claims, requests for more information, and overall delayed payment.
EMS billing companies are commonly the first out of the gate when it comes to sending patients their bills (and often for a good reason). If our bill to the patient is delayed because of our own actions, this can hinder our billing potential from both insurance payers and the patients, themselves.
6. Payer issues
Does the patient have insurance? Is there a deductible? How about in- and out-of-network copays or billing rates? What if the patient is experiencing a financial hardship? Different payer issues can all hold-up the billing process, particularly on the receiving end.
7. Misrouted claims
A simple typo or inadvertent switch in entering insurance policy numbers, social security numbers or even Medicare plan identifiers can all result in bills being held up or sent in the wrong direction.
8. Paying it forward
Sometimes, the billing pathways align and insurance companies cut a check right away, but that may not be directly to your ambulance service. In instances where the payer sends a payment to the patient, it is made in the full legal intent that the patient then pay this money forward to whomever is requesting it (like your EMS agency).
When this doesn’t happen – and the patient pockets the money – we lose out. We, then, look like the bad guy for having to shake these patients down in order to receive the money that was intended to pay for our services, not to simply line the patient’s pockets as an incentive.
9. No payment plan
In instances where a payment is due by the patient directly, a number of variables and hardships can burden their financial ability to actually pay for our services outright. In these hard times, asking for something is certainly better than getting nothing. Working with your patients to set up payment plans to pay off their debt can get money into our budgets at least in increments, as opposed to not at all.
10. Patient denies payment
For situations where the patient refuses to pay for our services, we have two basic options: write off this money or continue with the collections process. Different states have varying rules when it comes to tax refund interception or even collections and credit reporting practices.
Our decision as a biller lies in what is determined as acceptable regarding write-offs, zero payments and delayed billing processes. The key here is to remain consistent or face devastating effects on our bottom line and operations.
A solution to billing hold-ups
We all want efficiency, compliance and effectiveness in our billing practices, to reach our full reimbursement potential. Billing software can help your agency to stay on track, verify patient information and maintain compliance in your billing practices. Software solutions can track your claim’s progress, properly code for your services and give your agency the upper edge on overall billing cycle management (and flag these costly hold-ups along the way).
