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May 2011 

 

Claim Denials

 

Record Retention

 

Insurance Refunds

 

Documentation & Reimbursement

 

UPDATE

 

Multiple Patient Transports

 

Legally Speaking

Same Name, Wrong Patient

Financially Speaking

Collection Agencies

 

Incidents Before Midnight

 

Online Credit Card Processing

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Administration

 

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

Department Contact List
Financial Reports
Thank you for promptly submitting your transports for billing. Please send any remaining April transports to our office by May 16 in order to be included in your April financial reports.
Article8Insurance Refunds
We are continuing to process the Medicare bonus payments for transports from the first 6 months of 2010.  When Medicare sends these additional payments, they also forward the new co-payment amount to the secondary insurance.  We are finding that the secondary insurance is often paying the full co-pay amount a second time, creating an overpayment situation.

In many cases, we will be able to request an offset from the insurance company and they will recoup the overpayments.  However, some companies require a refund check.    You will probably notice an increase in the number of refunds as we work through these overpayments.
Article4UPDATE! 

Systems Design has been working with our clients to update their Railroad Medicare and L&I enrollments.  Enrolling in Railroad Medicare and L&I allows us to submit claims and receive explanation of benefits (EOBs) electronically.


If you received the enrollment documents from us, please sign and date all enclosed forms and return the originals to us as soon as possible. 

 

If you did not receive any paperwork from us, it means that your enrollment is already up-to-date.  We would like to thank all those who have already returned their completed forms.

multiptMultiple Patient Transports

Each insurance company is unique when it comes to paying for multiple patients transported together in one vehicle. Commercial payers will often pay in full, while Medicare and Medicaid reduce their allowable. We have found that using the Medicare billing rules works for all insurance companies.


Here's how the Medicare rules work. When multiple patients are transported together, each transport is billed using your normal fees. Systems Design includes a special billing modifier which tells Medicare there are multiple patients in one ambulance. Medicare automatically reduces the allowed amounts for any claim with this billing modifier.


Commercial insurance and auto policies generally pay at their normal rate even when there are multiple patients transported in one ambulance. For patients with no insurance who request a reduction, our office can contact you for a possible waiver.

incidentsIncidents Before Midnight 

There are times when an incident is dispatched before midnight and ends after midnight. It can be confusing to decide the correct date of service for billing. Here's how it works.


The PCR should be dated with the date of dispatch. When the transport comes to us for billing and we see that the incident spans two dates, we look for the time that the ambulance left the scene. The day the ambulance leaves the scene with the patient is the date of service that we must use for billing. Your monthly transaction journal report will also reflect the date that the ambulance left the scene instead of the dispatch date.

Gig Harbor Fire Chief Retires
  
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WELL DONE to Chief Bob Black who recently retired after spending almost 37 years in the fire service with 31 at Gig Harbor Fire.  Also a hearty congratulations to Chief John Burgess on his new appointment.

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Article1Claim Denials
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Reviewing claim denials is an important part of our billing and collection process. Claims are denied for a variety of reasons. Some of the common denials are related to insurance information, such as invalid ID numbers, patient not eligible or a different insurance is primary. We are able to gather updated information from the patient or the hospital to resolve these types of denials.


There are some denials due to documentation in the PCR, such as "not medically necessary" or "not a covered benefit" denials. Last month's newsletter featured tips on patient conditions that prove medical necessity. This month we have tips on destination information and how your documentation can reduce insurance denials.


One of the phrases in documentation that will result in a denial is "Patient's Choice". We see this phrase in PCRs when there is more than one appropriate hospital in your area and the patient is asked if they have a preference. To Medicare, this phrase means something completely different. Their definition of "Patient's Choice" means you are transporting the patient to a hospital outside of your local area because the patient wants to be closer to their physician or to their family. That type of transport is not a covered service under Medicare. For transports in your local area, select "nearest appropriate facility" as the destination reason.


The same is true for the phrase "Physician's Choice" when a patient is transported to a higher level of care. The Medicare definition of "Physician's Choice" is transporting a patient in order to be closer to the physician's practice. This also is not a covered benefit and the claim will be denied. Even though the physician specifies where the patient should be transported, select a destination reason such as "transport for the care of a specialist or specialized equipment".


You will occasionally have a patient who insists on going to a hospital outside of your locality, even though there are local hospitals that could treat their condition. In that situation, using "Patient's Choice" as a destination reason is appropriate.

Article3HIPAA & Record RetentionHIPAA Update 

HHS HIPAA Q&A: Retaining medical records

 
Q. Does the HIPAA Privacy Rule require covered entities to keep patients' medical records for any period of time?


A. No, the HIPAA Privacy Rule does not include medical record retention requirements. Rather, state laws generally govern how long providers must retain medical records. However, the HIPAA Privacy Rule does require that covered entities apply appropriate administrative, technical, and physical safeguards to protect the privacy of medical records and other protected health information for whatever period such information is maintained by a covered entity, including through disposal. See 45 CFR 164.530(c). (Link to WA records storage policy) (Link to AK records storage policy)

Editor's note: This Q&A is taken from the Department of Health & Human Services website.

Article9Documentation & Reimbursement
 approved claim  

Part 3: Destinations

The PCR should always clearly document the patient's destination.  For emergency responders, the destination is usually a hospital but there are other types of destinations, like skilled nursing facilities, assisted living, physician offices, MRI and CT imaging.  Some transports end in a transfer of the patient to air ambulance or another ground ambulance.  Each of these destinations, combined with the pick-up location information, determines who is responsible to pay the bill.


Medicare and Medicaid will pay for medically necessary transports to hospitals, skilled nursing facilities, the patient's home and dialysis.  Transporting a patient to a physician's office is not covered unless the stop is to stabilize the patient before continuing on to a hospital.


As a general rule, only local transportation is covered.  You can choose from the hospitals in your locality but if you are transporting far outside your usual area, Medicare will pay for mileage only to the "nearest appropriate facility".  You should document any time you are diverted or if the patient needs specialized care that is not available at your local hospital--these situations will be covered by Medicare.  For those transports where the patient insists on a hospital outside your area, document that the destination reason is the patient's choice.  The patient will be responsible for all or part of the transport cost.


See the article on Claim Denials above for more tips on destination documentation.

  

Next month's documentation topic, Mileage.

 

 

Article5 legally_speaking
Sharing Information on Federal & State Standards

Same Name, Wrong Patient
It's not unusual for a patient to call to dispute their bill, claiming they were never transported.  We verify patient information, such as their birth date and address.  Most of the time, the patient will begin to remember the event and the billing process can proceed.  Occasionally, we find that the person on the phone did not have a transport but someone else with the same name did.  While this would not be considered a HIPAA privacy breach, there are steps you can take when collecting demographic information to reduce the chance of this happening.

Whenever possible, demographic information should come from the patient or a family member.  The correct name and birth date, along with a social security number will ensure that the bill gets to the right person.  Relying completely on the hospital face sheet for this information can lead to errors, since the hospital could easily print records for a different patient with the same name.
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Article2REVENUE RECOMMENDATIONS

Does using a collection agency improve your organization's EMS revenues?!

 

The answer is yes, it does, but there are several points to consider as you determine your policies.  Would collections impact your image in the local community?  Could there be a negative effect on the levy approval process?


First, allow us to share some statistics.  The national average for net collections of healthcare related debt is 14 percent, and ER debt is closer to 6-8 percent according to the ACA International.  Transports through 911 would definitely qualify as ER debt and many of our clients have shared statistics that are similar or even lower with a return of only 4-6 percent of total dollars turned over to collections.


While there are some risks in using collections, there are also some risks if a collection agency is not used.  There are patients who have the means to pay but choose to ignore their bills.  Some withhold their insurance information or their signature, leaving us unable to bill their insurance.  And then there are those patients who receive money from insurance and do not forward payment.  These are certainly circumstances that qualify an account to be turned over to a collections agency.  In these cases, the threat of having the account sent to collections will often get the needed cooperation from the patient.


There is no doubt that some collections agencies are better than others and meeting with several different agencies will help you find the right fit.  We have learned collection agencies can tailor their approach to the way they treat the debtor based upon the way you want your residents and non-residents treated.

creditcardsOnline Credit Card Processing  creditcard-lg 
Systems Design and Official Payments Corporation has completed an arrangement to set up online credit card acceptance for our clients. The total processing cost is equal to 3.5 percent of the total transaction in addition to a minimum cost of $3.95 per transaction. The processing cost can be set up as a convenience fee assessed to the payer, excluding Visa, or billed to the Fire District, which includes Visa. If your organization is interested in providing this payment option to your Patients please contact Systems Design Administration dept.

 

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