Systems Design AdministrationToll Free: 800-585-5242
Phone: 360-394-7020
Fax: 360-394-7099
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 Direct Payment Legislation An important issue of concern to many of our Fire District clients is Direct Pay to Providers Legislation or Assignment of Benefits legislation. Insurance companies are lobbying against Direct Pay legislation and Fire and Rescue operations are lobbying for the legislation. Below is a link to various pieces of information on the subject that we have been researching. |
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Billing News...
Mixed Month Batches
We
are converting from cycle accounting to standard month end accounting. We will be asking all of our Fire Districts
not to mix transports from one month to the next in a batch. Most of our clients already comply with this
request. In order to provide timely
month end accounting we are requesting that we receive all of the transports by
the 15th of the month after the transports occurred.
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Events
Fall Conference
9/27-10/2/2010 |
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Previous Newsletters?
Maybe you missed a earlier newsletter, or want to refer back. Just click on the link below to view our Newsletter Archive page.
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 Medicare News
Fee Schedule Update
Medicare has started paying the urban, rural and super-rural bonuses. We had been eagerly awaiting these payment increases and immediately noticed that the payments were significantly higher than expected. After a little research and some phone calls, Medicare confirmed that they are overpaying the base rates by 22.6%. It appears that claims processed during a 2 week period will be paid at the incorrect rate.
Unfortunately, these overpayments will need to be returned to Medicare. It's likely that any payer secondary to Medicare will also pay the claims incorrectly and will require refunds.
Proposed Rule
Medicare has recently published a Proposed Rule that if implemented, will decrease reimbursement for ambulance services. Below are links to a letter from Page, Wolfberg and Wolf (PWW) that explains the details of the Proposed Rule and provides a model letter for submitting comments to Medicare. The Proposed Rule would require ambulance mileage to be reported to the nearest tenth of a mile starting in 2011. It would also apply an annual adjustment to the ambulance fee schedule that reduces reimbursement by what is called the "Multi-Factor Productivity"(MFP) adjustment. Click a link below to read more details about these and other proposed changes in the PWW letter. Proposed Rule Would Bring Negative Reimbursement Changes for the Ambulance Industry
Sample Comment Letter on Proposed Physician Fee Schedule Rule for Calendar Year 2011 |
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Playing the Insurance Game
While your agency is working to increase your revenue, the commercial insurance companies are finding ways to reduce their payments. You need to be aware of the latest game that they are playing. A claim is received by an insurance company and they send a fax to you requesting your signature in return for an "expedited payment". There is a catch--if you sign, you are also agreeing to reduce the billed amount by as much as 40%!
If you receive one of these faxes or if you receive a phone call asking to negotiate on a claim, you can forward it to our office. We handle many of these every day. We do not negotiate on any of your claims for 3 main reasons. First, there's really no advantage to accepting a lower payment when you can be paid the full amount. Second, discounting some bills and not discounting others could be considered a discriminatory practice. And third, your agency has an ordinance or resolution in place that stipulates your charges-there's really no room for negotiating without council or board approval.
We are happy to take care of these requests for you so don't hesitate to forward them to our office. |
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 Billing for Non-transport
We are often asked the question "Can we bill a patient or their Insurance if we do not transport them?" The answer depends upon the circumstances and who we would be billing. Here are some notes on that subject.
First of all, it's good to use a refusal policy and form to cover any legal issues that might arise after the transport. You probably already have these in place, but if you don't, there is a free sample of both a refusal policy and refusal form on the PWW website (www.pwwemslaw.com). The kind of documentation needed for legal issues is also important for billing issues.
Regarding what you could expect for reimbursement, the first thing to know is that most insurance will not pay and patients will usually need to pay out of pocket. Medicare will not pay, but in rare cases, we have been able to be paid by secondary insurance. Our process is to bill Medicare in order to get a denial and then forward the denial to the secondary, if the patient requests.
If the patient receives a bill and asks us to bill their insurance, we would certainly submit the claim and explain to the patient that their insurance will most likely deny. If it is denied, the balance goes back to patient responsibility.
Alaska Medicaid is the only big exception. They actually pay for treat and release. Their current manual shows that they reimburse $180.00 for this service.
We also believe it is a good idea for the Fire District's board to draft a resolution or policy directing Systems Design in what situations are billable and set an appropriate fee for each non- transport to be billed. The resolution should also detail any situations where your policies would exclude non-transport billing as well as when/if patients should be sent to collections if they do not respond to billing efforts. |
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Now THAT'S a Truck... |  |
BIG RED
Monster 1937 International Fire Truck
At 30,000 lbs and 38 feet long,
it is the world's heaviest and longest monster truck.
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