The field of emergency medical services such as transportation by ambulance is seeing lot of changes. The changes have been triggered by factors such as the way Medicare reimburses EMS agencies for ET3 i.e. emergency triage treatment and transport and community paramedicine programs. While the changes have been taking place very fast, the outbreak of COVID-19 has accelerated the changes, with the new normal still unknown.
The biggest challenge that all EMS providers are left to tackle is their accounts receivable. While this has been there since years, the outbreak of COVID 19 has changed things all the more. The one question common to all ems providers is ‘Our AR figure is mounting, and we are clueless.’ ‘Or where is all the money, we don’t know what’s happening?”. Just as the question remains common, there is one common answer to it – the cash is caught in some stage of the process or the figure is growing for few standard reasons.”
The problem with most EMS agencies is that they devote less time in processing their ems bills. Reason being, they have fewer staff to keep an eye on what is going on. This is why their AR collections takes a hit. To overcome this problem, they need an advanced software system so that the financial reports are accessible at the click of a button. This will tell them at any point of time what is going on and can apply dedicated experts to find out where the money is and why their AR growing?
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Now comes the question of prioritizing. Ideally if the bulk of the claims outstanding a payer are over 90 then bucket them because most of these claims should have been cleared within 45-days. If it touches the 90-day limit, means there’s an issue that needs to be addressed at the earliest. Having said that, your sweet spot should actually be between 60 days to 90 days else post 90 days, it’s next to impossible to get the claims reimbursed.
Prioritizing Payer Programs
The biggest payer for most ambulance agencies is Medicare followed by Medicaid. The two big players are followed by commercial insurance companies, facilities such as established nursing facilities and hospitals, and self-pay. As a practice Medicare claims are cleared very fast. Unlike Medicare, commercial companies take a bit more time. So, if there are a greater number of claims outstanding with Medicare, you need to prioritize it before others. Therefore, bucketing must be followed by the order mentioned above.
Commercial Payers
Here again you need to do a bit of a drill down. As a matter of fact, several states have framed laws that mandate the time frame by which commercial insurance payers must clear the outstanding. Most of them limit them to a maximum of 45 days. Therefore, the first thing you must do is to go through the claims data and find out the biggest payer i.e. Blue Shield /Blue Cross, Kaiser, Humana. Next, cross check the number of claims sent to the commercial payer and how many of them were reimbursed on time. Also calculate the average time taken to get reimbursed. The drill down will help you spot the problem and understand where to dedicate your staff to address the problem.
Facility Payers
These are transportation payment related to non-emergency work. Facilities such as physical therapy, doctor appointments, dialysis etc require patients to be picked up and dropped at the point of pick up. More often than not, EMS agencies tend to confuse the dues outstanding with facilities because they are too preoccupied in pursuing and collecting reimbursements from government and private payers. A distinct advantage here is that agencies also get to bill Medicare for some of the trips they undertake for facilities.
Not many EMS agencies are aware of the fact that the federal government gives a facility such as skilled nursing facility a fixed amount of money to meet patient care. A part of the money is meant for some pre-defined transportation costs that is not reimbursed by Medicare.
One more big problem is many EMS agencies do not want to spoil the relationship with facilities and so are unwilling to bill the facility for the transportation charges not reimbursed by Medicare. This is because they want to continue billing for transport charges covered by Medicare to Medicare and so give the billing to the facility a go-by.
Therefore, agencies need to have a different strategy for handling facility payers. They must make sure that their staff have the knowledge and training to distinguish between 2 types of trips and clearly understand which data set to use for billing payers. Access to correct data set helps your staff to generate correct bills.
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That being said, it’s never easy to have the right data at all times, which is why banking on software makes things a breeze. With the right software you can configure the bill to make sure every transport bill to a facility is mapped to the right payer. In other words, software helps you know the claims you must seek from Medicare and which from the facility, thereby helping you reduce your outstanding dues.
Self-Pay Patients
Self-pay patients are patients with higher deductibles private insurance plans. The deductible need to be realised before the insurance comes into play. What this means is that as, for many patients, the first touch point for availing healthcare services is an ambulance, submitting the claims bill to the payer, may not work if the deductible was not realized from the patient. This then becomes the agency’s liability. The best way to ensure this doesn’t become your liability is advanced software with insurance eligibility features.
The software can be used to find out the patient’s deductible status before the invoice is sent to the payer. If the deductibles have not been met, you can stake a claim with the patient upfront. Also, you need to keep patients updated constantly about their liability. And the best way to go about is to send text messages to them. In a mobile phone driven world, patients are more friendly to texts (than printed bills) that tell them on the ways they can clear their bills. This has proved to yield faster and assured outcomes than dispatching paper bills to them.
The two critical ways to improve the fiscal stability of your organization are bringing down your agency’s account receivables and having an exact understanding of where the money is stuck. If you take care of these two key, you will achieve fiscal stability with ease.
Who We Are and What Makes Us an EMS Billing Authority?
We at OutsourceRCM have over 10 years of experience in providing ems billing services to our clients. We are driven by experienced billers who bank on the most advanced EMS billing software to identify and eliminate common reimbursement issue and streamline the process of ems billings. Our process is vetted by QA experts who have a close look at every generated bill to ensure service accuracy. Our assigned reimbursement rates are in strict compliance with the listed charges in the Centers for Medicare and Medicaid Services website
