Inevitably, senior ambulance billers will (and should) influence EMS billing software decisions. EMS billers are constantly under fire when it comes to compliance, rejection/denial rates, and efficiency. It’s not easy for EMS billers to manage all the demands of ambulance billing while still maintaining quality. In order to meet the high demands of ambulance billing, EMS billers need a software that works for them and not against them.

EMS-oriented groups continue to lobby on Capitol Hill in Washington, D.C. and other major capitols to improve EMS reimbursement rates. Although we remain hopeful that government change will work in our favor, EMS administrators and managers continue to negotiate rates with private insurance companies and look for ways to increase billing efficiency. After all, what kind of EMS administrator or manager wouldn’t want faster and higher reimbursement on EMS insurance claims?

The holy grail of successful ambulance billing is an efficient EMS workflow that includes the entire ambulance service staff, from dispatch to first responders, EMTs, and medics to billers, all working together, and all on the same page. Clearly, open and effective communications, and EMS workflow between these key EMS operational areas will minimize the amount of time between dispatch, patient care and transport, billing, and receiving payment for services rendered.

We get it! You’ve performed all of the skills you’ve learned since First Responder class, on this one patient. The patient should name a kid after you, or at least the gold fish! Here’s the thing, we can chat all day long about how a call went, and hopefully that detail is in your PCR narrative (maybe minus the part where you used the Hurst tool to break open the patient’s medicine cabinet). But, if you don’t have that billing information on the ePCR and the patient’s signature on the signature form, you might as well call off your next shift. Or, at least hide from the billing office and the supervisor! They will hunt you down! Lack of billing info leads to lack of payment, making it harder for you to continue the lifesaving work we love you for.

Managing ambulance medical claims processing can be an extremely complex task—these best practices will help. An insurance claim is a collection of data: We transported this patient (patient demographics) on this day (DOS encounter data). They had this issue (coding), we did this for them (coding), and they have this insurance (insurance data). Get those five pieces of data right, and you will get paid; get any of them wrong or miss any information and getting paid is nothing short of a challenge. To help prevent EMS medical claims processing challenges like getting wrong information or not securing what you need—here are six important best practices to follow.

To keep pace with changes to health care reimbursement, EMS organizations need to reduce inefficiency in revenue cycle management. More people than ever have health insurance under the ACA and, of those, many have Medicaid. With this shift, the average per run reimbursement is lower for many EMS agencies, and the climbing deductibles are making it even more challenging to collect from patients. Additionally, modifications to the ambulance fee schedule have impacted EMS departments and have placed negative pressure on revenue. It's clear that the ACA has impacted EMS reimbursement in many ways, of which, these are only a few.

The new year is quickly approaching—that means new deductibles. How does your EMS Agency plan to handle exposure to deductibles this January? There is no way to completely alleviate the reduction of revenue your EMS agency will experience from deductibles, but there are ways to reduce your exposure. For instance, it's a common EMS billing practice to hold January Medicare Part B claims for 3-4 weeks before submitting. Sometimes it's longer, depending on the length of time that crossover takes. Doing this helps to reduce exposure to deductibles that minimize the number of patient pay claims. In other words, to reduce your exposure to deductibles, don't file too early in the year.

It's crucial for EMS Billing Staff to stay updated on key HIPPA rules. HIPAA, otherwise known as the Health Insurance Portability and Accountability Act, is an information security and privacy law that has made EMS billing more difficult to carry out due to its restriction of information uses from different healthcare providers. EMS billing has felt the burden of this legislation due to the introduction of electronic and Medicare billing within the last 15 years. Hospitals, nursing homes, and other healthcare providers that deal in medical records have become less forthcoming with information on patient care, and in turn, it has become more difficult to provide a seamless transition of information when attempted to provide the best patient care. This lack of education amongst other healthcare providers is just another important reason for educating EMS billing staff so that efficient ambulance billing and healthcare is maintained while being compliant with HIPAA.

See the benefits of outsourcing your EMS Billing and Collections and the superior value that AIM's EMS Billing Services provides. But first, let’s review the factors that a prospective EMS Billing Services user must evaluate. Is an EMS Billing Service Right For You?

Read the Center for Medicare & Medicaid Service's compliance reminder for EMS agencies that perform Advanced Life Support Ambulance Services. The bulletin focuses on the high number of errors related to insufficient documentation for ALS transports, highlighting the 2015 Comprehensive Error Rate Testing (CERT) Report that reflected an improper payment rate for ALS services of $226 million. Most errors occur when documentation: Does not support the medical necessity of the ALS level of service Lacks the patient’s signature authorizing the supplier to bill Medicare for the service