How important is immediate documentation in ambulance billing

How Important is Immediate Documentation in Ambulance Billing?

Subtitle / Points • The recent scams have hit the Ambulance service sector hard in the US. This has set the red beacon going and has led to changes in the way the CMS now views Ambulance billing. • The vigilance and tightening of billing services has impacted the reimbursements of the Ambulance services, now wary of the focus on how their services are being billed. • However, if one follows all procedures and guidelines laid down by the Medicare center, and follows the norms of the medical coding and billing methods with a fair knowledge of the workings, then one can be assured that the Revenue Cycle Management (RCM) process will not be impacted.

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Subtitle / Points • The definition “medical necessity” especially when it comes to applying for reimbursement from Medicare, of which 40-60 percent of ambulance reimbursements are derived via billing, is very crucial to understand when ambulance services are requested. The information noted should clearly spell out the medical necessity and demonstrate why the ambulance had to transport the patient to the hospital and its need.

• Describing the condition using qualifying words like “sudden onset of a medical condition” and pointing out the timetable of the event is necessary to meet the conditions laid down in the Medicare rule book and its definition. Without knowing if it’s a repetitive condition or a new condition- acute or otherwise, Medicare may refuse to pay, and thus the insurance may not pay too leading to denied claims and appeals for the billing service.

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Subtitle / Points • Transportation details are important since this is where fraud and scams can creep into the system.

• To avoid legal suits, it is very necessary to record the origin and destination locations & the number of miles traveled when transporting the patient from Point A to Point B, as Medicare doesn’t pay for many transportation services- so description and reasons mentioned in PCR documentation can bring support to the billers if and when claims are in the appeal process.

• To prevent any incorrect documentation of the scenario or input of key elements, PCRs should be written on the go and soon after depositing the patient. If there is a time lapse, one may skip important elements that can miss out on the input of crucial codes that affect the billing.

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Subtitle / Points • Prepare a checklist of what needs to be noted right from when the call has come through requesting for an “emergency service”.

• Keep certain terms handy specifically what constitutes “medical necessity” so as to reiterate information when one is writing up the final PCR. • Use recording devices if necessary to note down any minor observations, which could always bring the billers some support for the cause and reason. This will help when documenting the PCR covering all the vital points required by the medical billers and coders.

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