Billing Basics for EMS Gaffney SC

This issue sees the debut of Top Tips—a new column designed to provide practical, easy-to-implement information on all facets of EMS operations.

You are the manager of a moderate-size EMS organization comprised of both paid and volunteer members. EMS service to your community has traditionally been provided free of charge to residents, but your board of directors has convinced the town leaders that it is time to start billing. Your challenge is to create policy for your staff to follow to collect the necessary funds to meet your BOD's request. What essential things do your staff need to know?

Introduction

The world of EMS billing is often challenging and confusing territory for new EMS managers. There are specific requirements for appropriate collection of funds, most of which are found in lengthy, difficult-to-understand Medicare regulations. What is often misunderstood by management is that ignorance of, or failure to understand the laws of, patient billing is not an excuse for Medicare or insurance fraud. Here are five tips that may ease the transition to EMS billing:

1. Develop well-written, easy-to-understand internal procedures.

   One of the most common mistakes in the billing process is not adhering to appropriate policies and procedures. There are two steps in this process: The first is developing the policy, which is a tedious and time-consuming task. The key is to think of all possible scenarios. If possible, have legal counsel review your policy before you implement it, which is the second stage. Implementation starts by introducing it to all staff, then continual training and policy evaluation.

2. Perform an internal audit.

   This can be done by an administrative assistant, captain, agency officer or supervisor. Audit all runsheets prior to sending them to the billing company to ensure the appropriate information has been filled out. Pay special attention to the mileage section, which is often overlooked and may result in unbilled funds by the EMS organization. Refer to www.medicare.gov for more specific information on required data points.

3. Bill for all appropriate billable items.

   When instituting a new billing program, it is easy to miss services that can be billed by your agency. As stated before, mileage is a big-ticket item that is often overlooked. Pay attention to dispatch information. If dispatch information indicates ALS care is needed, but BLS care is actually given based on physical findings, you can still bill for portions of ALS care.

4. Obtain a patient signature.

   Patient care is the most important aspect of your response; however, there are also administrative items (usually handled at the hospital) that need to be completed. HIPAA law requires you to notify patients of their privacy rights and obtain their signature to confirm they received a copy. A patient signature is also required to bill their insurance for service. Develop simple, easy-to-read forms, and make an effort to include only information that is absolutely necessary. Consult your billing company or www.hipaa.org for more information about necessary components to your HIPAA signature form. A short insurance approval form can be created in a Word document. Again, keep it simple so your patient won't resist signing.

5. Find a good billing company.

   Most organizations are not large enough to have their own, so there is a fairly large market for billing organizations. Talk to agencies within your region for a referral. A good billing company will assist your organization in avoiding the pitfalls listed above. Research the company to find out how long it has been in business, how many "ambulance" clients it has, and what it would charge to recover funds for your organization. Develop a good working relationship with your billing company so, as laws or healthcare requirements change, you can adjust your practice based on their suggestions.

Conclusion

Recovering funds for your EMS organization can be challenging, whether volunteer or paid. When converting to an organization that bills for service, look at all the options and gather good information. Develop good internal policy, and have your EMTs and paramedics pay attention to detail. Following even a couple of these tips will pay dividends in the future.

Daniel E. Glick, BPS, AEMT-CC, is the executive director of the Mountain Lakes Regional EMS Council (NY) and a health service administrator for the 139th Aeromedical Evacuation Squadron, New York Air National Guard. He can be reached at deg3142@gimail.af.mil.