Stabilizing and transporting a sick or injured patient to the Emergency Department can be a stressful experience for EMS providers. Once you have successfully transferred the patient’s care to the hospital medical staff, you need to be paid by the insurance company for the transport you completed and the care you provided. However, there are several questions you must answer before you can submit a claim: During patient care, were your EMTs able to get all the information required for payment from the insurance company? Are the patient insurance information and demographics complete and accurate? Is your patient care report thoroughly documented, including any interventions performed in the field? Finally, do you have a staff capable of translating all the gathered data into an insurance claim that will be coded and reimbursed at the highest compliant level possible? If the answer to any of these questions is “no”, partnering with an EMS ambulance billing services partner could be beneficial for your company. EMS billing services companies have the time, expertise, and resources to address even the most challenging reimbursement issues faced by transport companies.
Ways an EMS Ambulance Billing Partner Can Increase Revenue
Patient demographics include key identifying information such as the patient’s name, date of birth, address, and insurance information. Stressful circumstances under which a patient is often transported can lead to inaccurate and missed demographic data, ultimately resulting in denied insurance claims. Valuable time must be spent to identify the reason for the denial. Was any demographic information missing? Was the information inaccurate? Even more time must be spent correcting errors and resubmitting claims. An EMS billing partner has numerous tools to verify the accuracy of demographics obtained from the patient or the patient’s representative at the time of transport. In fact, the same tools often can identify insurance information that was never provided by the patient.
It is critical for your EMTs to accurately and thoroughly document everything associated with a patient’s care and transport in the patient care report. Once that report is completed, a skilled medical coder must translate all care and services provided to the patient into codes that can be submitted on an insurance claim. Understanding the nuances of the ambulance billing process can be extremely challenging.
- Do we bill BLS or ALS?
- Emergency or non-emergency?
- Is your mileage accurately recorded?
- Are your clinical interventions documented so they can be used to support the type of transport and the medical necessity of such?
A certified ambulance coder has the knowledge and experience to analyze all aspects of a patient care report and determine the most appropriate and highest reimbursing codes for each patient transport.
Claims Follow Up
There are various outcomes after a claim is filed. Claims can be paid:
- At a rate less than your contractually-specified amount
- At an unacceptably low rate
- Or can be denied outright with no payment
An EMS billing service provider has expertise in addressing the different reasons ambulance claims might be denied and can effectively and efficiently work directly with your company, your patients, and, most importantly, the insurance carriers to resolve denials and receive payment owed.
With the passage of the Federal No Surprises Act (NSA), balance billing for out-of-network air ambulance claims is prohibited. Ground ambulance claims currently are exempt from the NSA, allowing more effective negotiation with non-contracted payers when their payment amount is unacceptably low. An EMS billing services provider has the knowledge and strategies to fight low payments and often realize a higher final payment through diligent communication and work with payers.
After final payment is received from the patient’s insurance company there likely will be an additional patient balance due. An EMS billing partner can send clear and concise invoices to patients for the amount they owe. If patients have questions or concerns, the same partner can provide a customer service department to assist in answering those questions. Finally, a well-staffed partner can call your patients directly to bring a personal touch to the collection of patient-responsible amounts.
Working with an EMS ambulance billing services partner to focus on the health of your business allows you to focus on what matters the most – providing caring transport to your patients–while increasing your revenue through the expertise and efficiencies of a dedicated billing partner.
If you’d like to learn more about Gryphon Healthcare’s EMS Billing Services, schedule a call with our client development team. In the meantime, download our whitepaper about how outsourcing revenue cycle management to a partner like Gryphon can help you save time, energy, and money.