header big block arial 

 
February 2011

Payment of 2010 Bonuses

 

Health Information Exchange

 

- Innovation Zone-

Documentation & Reimbursement

 

- UPDATE-

  
  
- Legally Speaking -
  

SDW Logo 130x42

Administration

 

Toll Free:  800-585-5242
Phone: 360-394-7020
Fax: 360-394-7099

Department Contact List
Article2innovation_zone
Health Information Exchange is coming...
Many government and health care agencies are working rapidly towards an integrated network of patient medical information (electronic health records).  These records will be available to hospitals, clinics, physicians and EMS providers, as the federal government is funding and proposing that all U.S. medical records be computerized within 5 years.
 
The creation of a National Health Information Network will enable electronic health records to be available to EMS personnel on scene at the patient's side.  Click HERE to view an HIE presentation by Kelly Curry.

Article4UPDATE!
Fractional Mileage

The change to reporting mileage in tenths of a mile has gone very well.  Most insurance companies are processing and paying the claims correctly.  We appreciate all your efforts to help make this a smooth transition.

Article8NEW 2011 Federal Poverty Guidelines 

On January 20th, the Federal Department of HHS published the annual update to the Poverty Guidelines.  These guidelines establish revised income levels used by many of our clients in their Charity/Waiver evaluation process.

Federal Registry:
Poverty Guidlines Calculations:

We are currently reviewing each client's Charity Application or Waiver Request to ensure they are in line with the new poverty levels.
Article7Financial Reports Access
web reports

 

As we have reported in our previous newsletters, our web server project is complete.  Our clients can now log in and obtain their monthly financial reports; we will be sending an email to each of our clients providing a login and password to access your account.  In the coming months we are hoping to cease printing and mailing these financial reports.  Phase Two of this project will enable our clients to drill down to a patient account level and obtain account histories.
Previous Newsletters?

 

Maybe you missed an earlier newsletter, or want to refer back.  Just click on the link below to view our Newsletter Archive page.

 

 archive
Quick Links
 
Join button
article1medicare moneyPayment of 2010 Bonuses
Many of you have asked when Medicare will reprocess and pay the urban and rural bonuses from the first half of 2010.  Just in time for this newsletter, Medicare has announced their plan to begin payment of these bonuses in the next several weeks.  This process will take a considerable amount of time, as they must reprocess every claim for a 6-month period.  They also are working to ensure that new claims coming into the system are not delayed by this reprocessing project.

Article3Red Flags Rulered flag

After several delays, the Red Flags Rule was implemented on December 31, 2010.  The Red Flags Rule is a set of regulations developed by the FTC requiring "creditors" to implement written identity theft prevention and detection programs into their day-to-day operations. 

Recent changes in the law have exempted many ambulance agencies from being defined as a "creditor" however some agencies might still need to comply with the Red Flags Rule.  The term "creditor" is defined as an entity that "regularly and in the ordinary course of business:

  1. Obtains or uses consumer reports, directly or indirectly, in connection with a credit transaction;
  2. Furnishes information to consumer reporting agencies in connection with a credit transaction; or
  3. Advances funds to or on behalf of a person, based on an obligation of the person to repay the funds or repayable from specific property pledged by or on behalf of the person."

If your agency falls under one of the above-mentioned categories, you must comply with the Red Flags Rule. 

Systems Design has implemented an identity theft program that is compliant with the Red Flags Rule.  The program identifies activities on a patient's account that might be a "red flag" of possible identity theft and how we will respond.   You will find a copy of our program at the following link: Click Here

Article9Documentation & Reimbursementapproved claim
Documentation has many important uses besides reimbursement.  It is the legal record for your agency and for your patients, is shared with hospitals to provide continuity of care and is used for internal data collection and quality assurance.  Over the next few months, our newsletter will feature a series of articles on documentation from the billing perspective.  This first installment is focused on the dispatch information that is crucial to billing.

Part 1:  Dispatch
Let's start with the "How" of dispatch.  To be considered an emergency transport, Medicare has 2 requirements:  1) the dispatch must be through a 911 or equivalent system and 2) the response must be immediate.  This means the PCR needs to describe HOW you were dispatched and HOW you responded, even if 100% of your calls come through 911.

This information can be documented in the narrative section, for example, "Dispatched emergency ALS for difficulty breathing, responded immediately to residence at 123 Elm St".   Using software that has a section for dispatch information with response times and response level also documents this information.

If the patient condition at dispatch requires an ALS emergency response but the transport is later downgraded to BLS, you are allowed to bill an ALS assessment.  To qualify as an ALS assessment, Medicare has 3 documentation requirements:  1) it must be an emergency transport; 2) the patient's reported condition at dispatch required an ALS crew and 3) ALS crew performed a hands-on assessment.  The dispatch information is crucial to be able to bill at the ALS level.

 

Now let's look at the "When" and "Where" in dispatch information.  Dates and times are always important, especially when there are multiple transports on the same day.  Submitting a claim with an incorrect date can result in a denial.  If we are able to see that the date on the PCR is incorrect, we will ask for an amended report.

 

The point of pick-up sets the rate that Medicare will pay for the transport. The zip code of the pick-up location must be included on the PCR to document whether the transport should receive an urban, rural or super-rural bonus.  If the point of pick-up is a facility such as a hospital or dialysis center, include the facility name in the PCR.

 

Keep in mind that the PCR is the main source to prove which services were provided--and proof equals payment!

 

Stay tuned for next month's documentation topic, Medical Necessity.

legally_speakingArticle5 
Sharing Information on Federal & State Standards

EMT Signatures

When you look at all the elements that go into documenting your PCR, requiring the crewmember's signature seems very straight-forward.  As our jobs become more paperless, the definition of a signature also changes.  With the enormous emphasis on health care fraud, signatures have become an area of increasing scrutiny by Medicare and Medicaid--and not just for ambulance providers, but for physicians and hospitals, too.


Medicare implemented new signature rules during 2010 and we see the effects of this change when we submit medical records for an appeal or an audit.  If the signature does not meet the standard, none of the medical record can be used and payment is denied.  This has a major impact on our ability to collect payment.


Here is what the law requires--medical services provided must be "authenticated by the author".  This is fulfilled by a signature on the PCR.  The signature can be either hand written or electronic.  Medicare further defines what makes each signature type valid.


Handwritten Signatures
A hand written signature on a PCR must either be

  • legible; or
  • illegible with the name clearly printed below the signature; or
  • illegible with a signature log attached

Here's the way a signature log works.  Your agency would keep an example of each EMT's signature.  If we need to send a PCR to Medicare and the signature is not legible, we would request a copy of the signature log from you and send it to Medicare with the PCR.  A signature log might look like this:
 

sig log sample 

Electronic Signatures
For the electronic signatures, just having the EMT name printed on the report is not enough.  Medicare requires a short statement that clearly shows the person named is authenticating the report.  "Authenticated by", "Reviewed by", "Verified by" or "Electronically signed by" would all satisfy this requirement. We suggest that you work with your IT or software support to have this added to your reports, if possible.


If we need to submit a PCR to Medicare that does not have a valid signature, we will send you a statement that attests to the validity of the report for the EMT to sign.  Click HERE to see the attestation statement.

 

 

Article6Systems Design appoints Leslie Sheridan as Chief Operations Officer.

We are proud to announce Leslie's promotion from manager of the insurance services department to the position of director of our operations. Leslie has years of banking operations management experience and the organizational skills and management abilities to successfully lead our billing operations. We are always looking for ways to improve our processes, develop our staff and provide our clients the kind of professional service they expect and deserve. She will work side by side with our management team and the Systems Design staff to further develop our processes and ensure continued quality EMS billing services. Leslie's direct line is (360) 394-7031 for any questions or concerns you may have.
 

Systems Design welcomes Kate Lindsey.

Kate has recently joined Systems Design as our software project manager. She will assist our programmer and the Technology Department with ePCR connections and electronic data transmission for our clients, provide technical support to our clients and manage various internal and external software projects. Kate is a former Microsoft program manager and has also worked at Apple and Amazon.com. We are very excited that she has joined our company.
 

Systems Design Departments and Contact Information

 

Billing Services: (Karen Guay) The Billing Services department performs the work on the incoming transport billing (paper & electronic patient care reports), developing and submitting the claims to the payers, and handles the mailroom operations.

(800) 585-5242 (360) 394-7040 Direct

Patient Services: (Juls Clare) The Patient Services department administers all patient services such as call intake, patient insurance information, patient invoices and statements, client billing policy and procedures and collections work.

(800) 585-5242 (360) 394-7010 Direct

Insurance Services: The Insurance Services department performs the follow up work on all of the insurance claims that were submitted and not paid or denied for various reasons. This department performs appeals of denied claims and follows through on the claims until payment is received. Any questions related to this department are directed to the Administration group.

(800) 585-5242 (360) 394-7030 Direct

Accounting Services: (Lori Christenbury & Cindy Tomeo) The Accounting Services department performs all of the financial transaction work including insurance and patient payment posting, preparing deposits, administering refunds and adjustments, accounting QA and preparing month end financial reports.

(800) 585-5242 (360) 394-7060 Direct

Administration and Client Services: The Administration and Client Services Department performs all of the corporate management and client administration services, legal work, technology administration, IT work, compliance rules and regulations, financial projections, provider credentialing, new client set up services, and production management & support.

(800) 585-5242. (360) 394-7020
 

Mark Spice - Chief Executive Officer

Leslie Sheridan - Chief Operations Officer

Shelley Brewington - Senior, Executive VP

Michael Philbrick - Chief Technology Officer

Jody O'Brien - Compliance Officer

Mike Dunn - IS & IT Director

Donna Martin - Client Services

Cindy Tomeo - Financial Analyst

 

 

Systems Design and the Systems Design Logo are registered trademarks of Systems Design West, LLC.  All other logos and trademarks are the property of the individual companies and are used by permission.