City of Solon EMS Billing Presentation

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Medicount Management, Inc. 10361 Spartan
Dr Cincinnati, OH 45215 1-800-962-1484
The Industry Leader
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Debbie Fillnow Provider Enrollment

• ALS vs. BLS
• Medical Necessity Requirements
• Billing Methods
• National Fee Schedule
• National PIN
• Drug Licenses and Certification

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Determining Level of Service
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ALS 1

• Transportation by ground ambulance vehicle,
  medically necessary supplies and services and
  either an ALS assessment by ALS personnel or the
  provision of at least one ALS Intervention.
• ALS Intervention means a procedure that is beyond
  the scope of authority of an emergency medical
  technician-basic (EMT-Basic).

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ALS 2

• Advanced Life Support 2 Transport- Advanced life
  support, level 2 (ALS2) is the transportation by
  ground ambulance vehicle and the provision of
  medically necessary supplies and services
  including (1) at least three separate
  administrations of one or more medications by
  intravenous push/bolus or by continuous infusion
  (excluding crystalloid fluids) or (2) ground
  ambulance transport and the provision of at least
  one of the ALS2 procedures listed below.
• 1. Manual defibrillation/cardioversion2.
  Endotracheal intubation3. Central venous line4.
  Cardiac pacing5. Chest decompression6. Surgical
  airway7. Intraosseous line

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Determining Level of Service
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Determining Level of Service

• Is Ox
• Is Oxygen considered a Drug for the Purpose of
  Determining ALS II level of service?
• No, Oxygen is not considered a Drug.
• Is Aspirin considered a Drug for the Purpose of
  Determining ALS II level of service?
• No
• Dispatched to scene of accident. Loaded patient
  and transported patient roughly 1 mile to site of
  helicopter for life flight to trauma hospital. My
  understanding would be to have the ground
  ambulance bill their level of care provided to
  the insurance company with a modifier of (S)
  scene to (I) Intercept.
• Yes. The ambulance supplier transporting the
  beneficiary would bill Medicare for the level of
  service provided and mileage from the scene of
  the accident to the point of transfer to the air
  ambulance. Medicare covers the transport of the
  beneficiary and the medically necessary services
  provided to the beneficiary.

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Medical Necessity
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Methods of Billing
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Nation Fee Schedule
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National Fee Schedule
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Implication of Fee Schedule
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National Provider Identifier

• The Health Insurance Portability and
  Accountability Act of 1996 (HIPAA) mandated that
  the Secretary of Health and Human Services adopt
  a standard unique health identifier for health
  care providers. On January 23, 2004, the
  Secretary published a Final Rule that adopted the
  National Provider Identifier (NPI) as this
  identifier. 
• All HIPAA covered healthcare providers, whether
  they are individuals or organizations, must
  obtain an NPI for use to identify themselves in
  HIPAA standard transactions. Once enumerated, a
  provider's NPI will not change. The NPI remains
  with the provider regardless of job or location
  changes.
• HIPAA covered entities such as providers
  completing electronic transactions, healthcare
  clearinghouses, and large health plans, must use
  only the NPI to identify covered healthcare
  providers in standard transactions by May 23,
  2007.

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Drug License and Annual Certification
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EMS Claim Processing

• Dept. Summary
• Electronic Uploads
• Documentation
• Resident vs. Non Resident
• Face Sheets
• RTML and Skip Tracing
• Mutual Aid Billing
• Reasons for Denials
• PDPR/ PDPT
• Discount Requests

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Billing Departments

• Data Entry
• Status Claims

• Patient Relations
• Payments

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Electronic vs. Paper uploads

• Stone age or Computer Age?
• How to transmit your data to State, TPA.
• Face Sheets!

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Soft billing is a common misconception, it is not
Insurance only billing

• Residents
• Insurance Billing only
• No out of pocket expense
• No insurance, No Fee
• Non-Residents
• Insurance Billing
• Soft Billing approach all co-payments
• Soft Billing for those uninsured

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Proper Documentation

• Resident Designation
• Proper spelling of patient name and address.
• Correct date of birth and social security number.
• Patient insurance information (Face Sheets)
• Patient phone number

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Patient Assessment

• What is the patients chief complaint?
• Descriptive narrative and patient notes
• Documenting patients vitals
• What services were administered to the patient
• The rank of the EMS crew

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Implication of Billings

• Financial Hardship- Financial considerations will
  be offered for all those patients without the
  wherewithal to satisfy any balance
• Hospital requests- There will be no change in
  your current protocol when specific hospitals are
  requested.
• Visitors of Residents- If the guest of your
  resident requires a transport and does not reside
  inside the district, the patient is to be
  considered a non-resident.

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_________ are like gold.


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Return Mail and Skip Tracing

• NCOALink48 NCOA. The National Change of Address
  database holds over 152 million moves, archived
  for the past 48 months. Especially for
  healthcare applications where you may see a
  patient only every year or so, it is far superior
  to FastForward, which archives for only the past
  eighteen months. The proper use of NCOA allows
  us to eliminate approximately 85 of would-be
  return mail.
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• AEC. After sending your addresses through NCOA,
  any address that does not receive a Delivery
  Point Barcode, is sent back to the USPS for
  Address Element Correction AEC. AEC corrects
  misspellings, missing directionals (S,N, SW,
  etc), missing suffixes (ST, DR, AV) etc. This
  service enables us to get Delivery Point Barcodes
  for over 65 of the 15 that was rejected by
  NCOA. The result to you is dramatically reduced
  return mail.
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• Selective Suppressions. We suppress that piece of
  mail from printing and send you a report of all
  such suppressions. The most common reasons for
  address suppressions are Moved, Left No
  Forwarding Address and Undeliverable as
  Addressed. More than 50 of the mail that is
  undeliverable at this point is because an
  apartment number or suite number was missing.

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Mutual Aid Billing

• Only ONE ambulance supplier can submit a claim
  for the service.
• The involved suppliers must determine who will
  submit the claim and how the reimbursement will
  be distributed.
• When a patient is transferred from a BLS vehicle
  to an ALS vehicle, the ALS service may be
  allowed.
• When ALS personnel and equipment are placed
  onboard a BLS vehicle, the BLS vehicle is
  qualified as ALS and an ALS service is allowed.
• When a BLS vehicle transports a Medicare
  beneficiary to a rendezvous with an ALS vehicle,
  and ALS personnel and equipment join the patient
  in the BLS vehicle, the trip is allowed as an ALS
  service.

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Reasons for Denials

• The Medicare ambulance benefit is a
  transportation benefit only. Without a transport
  there is no payable service.
• When multiple ground ambulance providers respond,
  payment will be made only to the ambulance
  supplier that actually furnishes the transport to
  the destination. (If Mutual Aid is involved,
  refer to that section.)
• Ambulance suppliers that arrive on the scene but
  do not furnish a transport are not due payment
  from Medicare. (Exception See Death of
  Beneficiary Section.)
• No payment will be made for the transport of
  ambulance staff or other personnel when the
  beneficiary is not onboard the ambulance.
  Example an ambulance transport to pick up a
  specialty care unit from one hospital to provide
  services to a beneficiary at another hospital.
• Ambulance transport is NOT covered when other
  means of transportation could be utilized,
  without endangering the patients health.
• When submitted documentation does not support the
  medical necessity.
• Codes submitted that are not listed in this
  article.
• When the use of ambulance services was
  unreasonable because the treatment of the illness
  or injury could be provided without requiring the
  beneficiary to be transported to a covered
  destination.
• Medicare will not pay for an ambulance service
  when an ambulance was used for convenience or
  because other means of transportation were not
  available.
• Ambulance service will be denied when the patient
  is generally mobile and able to safety walk or
  move to the vehicle with or without assistance
  including the use of a cane, crutches, walker or
  wheelchair.

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Lost Checks Lost Revenue

• Insurance Paid Patient
• Analyze total revenue distributed and lost to
  patients vs. total reduction in revenue from
  accepting assignment

• Insurance Paid Provider
• Ensure that all members of the staff that have
  access to incoming mail knows to forward EOBs to
  TPA.

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Discount Requests

• Multiplan, Concentra, ..
• Ask them Why should I accept your offer?
• Many times the only answer is a faster turn
  around for a 30 discount.

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Quality Control

• Client Logs
• Charge Report
• Credit Report
• Adjustment Report
• 12 month charge/credit analysis
• Quality control auditing
• SAS 70 audit
• Dan Owens, Von Lehman co.

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Client Log, Account Summary
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Detailed Charge Report
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Detail Credit Report
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Detailed Adjustment Report
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12 Month Charge/Credit Analysis
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Level 2 SAS 70 Audit

• Dan Owens
• Von Lehman Co.