Compliance management in Ambulance Transportation Billing and Coding

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• Compliance management in Ambulance Transportation
  Billing and Coding

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Compliance management in Ambulance Transportation
Billing and Coding
Ambulance transportation billing and coding
involves a various compliance challenges, which
if not followed can result in decreased revenue
and an organized billing cycle. The ambulance
industry as a healthcare field over the years has
seen a significant number of false claim cases,
fraud investigations, and audit activity, and
other types of charging related cases. This is
the very reason ambulance transportation billers
and coders fully understand the nuances of
reimbursement to successfully sidestep these
unwanted errors. Here are some significant
issues in ambulance transportation billing that
includes some of the most common and serious
challenges in the field of ambulance medical
billing. Whats the necessity? The first and the
most important thing is the medical necessity for
ambulance transportation service, which continues
to be the biggest compliance issue in billing.
Like any other type of healthcare service,
ambulance transportation must meet medical
necessity rules in order to be covered.
Nevertheless, when it comes to ambulance billing
and coding, the medical necessity criteria seem
to be vague and less defined than in other
medical specialties.
Medical Billing Services in Oregon
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Compliance management in Ambulance Transportation
Billing and Coding
According to the federal law medical necessity
for ambulance transportation is when other means
of transportation are contradicted by the
patients condition. While the new CMS
regulations and manuals provide some added
clarification, the medical necessity standards
for ambulance transport are aligned on whether
the patient could safely be transported by other
means. In simple terms if a patient could safely
be transported by car, a wheelchair van,
stretcher van, or any other means, then it should
remembered that the medical necessity is not met,
and in this scenario reimbursement cannot be
made. It is also critical to note that when
evaluating medical necessity, only the patients
condition matters it is irrelevant if those
other means of transportation are
unavailable. Billing for Advanced Life
Support Another major compliance risk area in
ambulance transportation billing is the use of
high paying advanced life support (ALS) codes in
cases where lower reimbursed basic life support
codes should be used. ALS levels of service can
be charged only when the skills required to care
for the patient exceed the scope of practice of
an EMT-Basic in that jurisdiction. As a result,
an ambulance biller must know what the approved
scope of practice consists of for EMTs in that
jurisdiction, and what skills require licensing
or certification above that level.
Medical Billing Services in Oregon
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Compliance management in Ambulance Transportation
Billing and Coding
Training makes you better Lastly, a vital part to
keep up with ambulance transportation billing and
coding compliance is to ensure that all your
billers are precisely trained in the unique world
of ambulance billing and coding. It is precarious
to assume that billing and coding knowledge of
other healthcare specialties are automatically
applicable to ambulance transportation billing.
Keep in mind that ambulance transportation coding
and billing has its own twists and peculiarities,
and billers should receive specific training
related to ambulance in order to follow the
billing compliance.
Medical Billing Services in Oregon