Ambulance Medical Billing Services | XyberMed

To manage ambulance billing, it is important to find a dedicated team that understands complete revenue cycle management, including optimized medical coding, proper and timely claims submission with expert accounts receivable management, and improved denials management.

An insurance claim is a set of data indicating that we transported this patient (patient demographics) on this day (DOS encounter data). He had this problem (coding), we did this to him (coding) and he has this insurance (insurance data).

If you get those five pieces of information correct, you will get paid, but if you get any of them wrong or omit any information, getting paid will be a challenge. To help prevent EMS medical claims processing challenges such as getting incorrect information or not insuring what you need.

Managing ambulance medical billing claims processing can be an extremely complex task, these best practices will help. Here are six important best practices to follow: BEST PRACTICE #1 UNDERSTAND THE DIFFERENCES BETWEEN APPEALS AND CORRECTED CLAIMS. When ambulance claims are denied, billers can either appeal the claim or file a corrected claim to seek reimbursement for services rendered. To ensure proper reimbursement, all billers handling denials should understand the difference between the two and should follow state and payer guidelines for submission. ⇒ When a claim is appealed, the insurance payer is advised that the billed codes are correct, and further documentation is provided to show that the codes are reimbursable as billed.

In the case of an appealed claim, you must provide documentation to support your appeal. Be sure to include the patient care record/story, any pertinent amendments, the bill, your official appeal letter, and a copy of the original claim. There are state-specific guidelines that can be used, as well as payer-specific appeal processes. ⇒ By submitting an amended claim, you are advising the insurance payer that you would like to modify items such as the CPT, ICD-10, and/or HCPCS codes originally billed. Knowing the difference between these codes is important so that the claim is reprocessed correctly and promptly.

Appropriate changes should be made to the CPT, ICD-10, or HCPCS codes, and the bill type should be changed to reflect a corrected claim. Failure to change the bill type could result in

rejection as a duplicate bill. The corrected claim should be sent electronically to ensure faster reprocessing.

BEST PRACTICE #2 - REVIEW REJECTION REPORTS DAILY. Review all electronic claim rejection reports daily to determine where in the routing the claim was rejected.

Reviewing the reports will allow billers to determine if the cause of the rejection was internal, with a clearinghouse, or with a direct payer.

If the errors were introduced by billing personnel, billers can take steps to improve processes and reduce internal errors. If errors appear elsewhere in the process, billing managers should determine why claims were rejected and then call the clearinghouse or payer to investigate further.

Some of the most common rejections are for invalid insurance identification numbers, missing dates of birth, invalid diagnosis codes, demographic errors, and misspelled names. Many of these can be avoided if you have quality billing software that allows you to implement safeguards to prevent the most common billing errors.

BEST PRACTICE #3: SCRUB CLAIMS FOR ERRORS PRIOR TO SUBMISSION. "Scrubbing" includes spot-checking major payers for compliance issues, diagnostic problems, and other potential coding errors.

If the scrubbing process is clearly defined, it can greatly improve the chances of having a clean claim that reduces days in receivables and increases your reimbursement.

Another aspect of debugging is making sure you are using the correct codes. By taking advantage of ambulance claims management technology tools and not sticky notes all over your computer, you will automate your processes and ensure that your forms are up to date with ever-changing ambulance coding guidelines.

BEST PRACTICE #4 - IMPLEMENT PROCESSES THAT REDUCE THE LIKELIHOOD OF CLAIM REJECTIONS. You can reduce the chances of claims being rejected by implementing processes that reduce the likelihood of claims being rejected in the first place. To do this, billers should be aware of each payer's electronic claims submission path.

Knowing the claims path can also give billers a better idea of how long it will take for claims to reach payers.

Electronic claims are sent to an EDI company and, in some cases, to several trading partners before the claim reaches the payer. The longer the path the claim travels, the more likely it is that errors will occur.

Billing managers can start tracing the path by following a claim from the ambulance provider to the provider's EDI company and then determine whether the claim goes directly to the payer or to an additional trading partner. To reduce the number of steps in these pathways, look for EDI companies that have direct contracting agreements with most, if not all, of your EMS agencies' major payers.

BEST PRACTICE #5 - IMPLEMENT AN INTEGRATED EMS WORKFLOW. Revenue cycle management works best when all systems and departments are fully integrated.

However, many EMS billing departments, dispatch offices, and patient care departments remain in their own silos working independently.

A five-star claims management solution can provide reporting and analysis capabilities to help you uncover the hidden causes of problems and engage departments throughout the revenue cycle for a cleaner, more transparent workflow.

Our EMS workflow links departments (dispatch, ePCR, and billing), reporting, and analysis seamlessly. Because our software is cloud-based and able to fully integrate all vital departments, it avoids the most common electronic claims rejections and is always up-to-date on the constantly changing requirements of your payer mix, state requirements, and changing reimbursement methods.

BEST PRACTICE #5 - CONSTANTLY MONITOR THE STATUS OF CLAIMS. An EMS biller can do a great job of getting claims out the door but may fail to follow up on the status of claims once submitted.

If the EMS provider does not have a documented process on how and when to follow up on outstanding invoices, the likelihood of collection will decrease and the work required to clean up accounts receivable will increase.