There are several good practices that ambulance service providers can adopt to help ensure EMS billing is effective and successful. Effective EMS billing is defined as billing that produces timely and accurate claims, which in turn reduces accounts receivables and increases cash flow.
Best Practice #1: Have good dispatch protocols.
The first step toward effective EMS billing, is ensuring that the appropriate priority and level of service are determined each time. Good dispatch protocols are important, because this helps accurately determine whether to respond emergently and helps ensure billing of the appropriate level of service up front. Dispatch protocol may also be dictated by the standards set by a specific state or jurisdiction.
Best Practice #2: Produce strong documentation and have well-trained field operations.
Documentation is one of the most important aspects of EMS billing. Well-trained field operations staff have a strong appreciation for the importance of their patient care reports (PCRs). The PCR serves a vital clinical purpose, as it contains the information to help medical professionals determine next steps for the patient. This documentation also plays an important role in billing and reimbursement. The PCR is vital to EMS providers’ to accurately determine medical necessity. Since Medicare accounts for 35% – 50% of the revenue in most EMS organizations, it becomes that much more important to provide sufficient documentation to ensure reimbursement.
Best Practice #3: Have well-trained Billing staff and produce accurate claims.
Regardless of how strong the documentation is, accurate claims submission is only as good as the trained individuals handling them. Well-trained billing staff understands how to review PCRs and accurately determine medical necessity, as well as level of service. In EMS billing, if there are claim submission errors, this can result in denials, delay reimbursement, and increase accounts receivables.
Best Practice #4: Automate workflows where possible to increase productivity and reduce errors.
In today’s world, there are multiple streams of technology available to help build efficiencies around EMS billing and help reduce errors. Automation can help make workflows more efficient, by quickly identifying existing accounts during data entry, automatic insurance verification, automated management of fee schedules, invoicing, and tracking/sending collection accounts through the revenue cycle.
Best Practice #5: Timely Follow-up with Payers on Claims Submissions and Identifying Payer Issues.
All payers have a timely filing limit that dictates the last date which a claim can be submitted to them for processing. While it is important to submit claims on time, it is also vital to proactively follow up on those submitted claims and, when possible, gain access to the online systems of those payers. Online access to payers’ websites helps EMS providers view claims status, submit disputes, and view any updates to payer billing requirements. Timely follow up on claims that may have been stalled can help EMS providers identify issues with claim submission, or at times, issues within the payor’s processing system that may be causing claims to deny, stall, or not process at all. The sooner these issues are identified, the sooner it can be corrected, and claims can be process for payment, which obviously increases cash flow and improves account receivables.
In closing, an effective EMS billing processes include rules and guidelines that provide clear direction to field operations on transport documentation, clear guidance to billing staff on how to properly bill claims for payment and takes advantage of the available technology that helps build efficiencies, increases revenue and reduces AR, as well as denials.