Providence Health & Services and Systems Design have signed an agreement that gives Systems Design access to patient accounts within the Providence Health & Services Systems through One Health Port. This will eliminate the need for Systems Design's clients to obtain and provide the hospital face sheets for billing. Access to the hospital's information will streamline the insurance information process, enable us to verify and bill insurance without requesting insurance information from the patients, improve the clean claims process and improve revenue recovery for our clients.

For those of you who use the free signature form developed by Page, Wolfberg and Wirth, there is a new updated version. 

You can download the new form at: http://www.pwwemslaw.com.

Once you have clearly documented your Patient Care Report (PCR), there are a few final steps to complete the process.  First, make sure you have signed the PCR.  For hand-written PCRs, sign your name and print it underneath with your credentials if the signature is not legible.  For electronic reports, there should be a statement as to who wrote the report-something like "verified by" or "reviewed by" with the EMT's name and credentials.  Without a signature, the documentation cannot be used to dispute a denial, which makes receiving payment much more difficult.
Second, make sure you have a signature from the patient or a family member.  Many insurance plans require an authorization from the patient before billing.  If there is a medical reason that the patient is unable to sign and no family members can sign, document the reason and ask someone from the receiving hospital to sign.
Third, whenever possible, pick up a hospital face sheet.  The insurance information on the face sheet allows the billing office to submit claims quickly and receive payment within two to three weeks.
If your agency performs scheduled, inter-facility transports, you will also need a Physician Certification Statement (PCS).  The PCS documents the patient's condition and why the facility is requesting a transport.  A free PCS form is available on the Page, Wolfberg and Wirth website at http://www.pwwemslaw.com.  The PCS does not replace your Patient Care Report-the PCR should still fully document the transport details.
With each of these steps, the forms enable quick billing of the claim to the correct payer and turning your report into revenue. 

The primary duty for our patient services specialists is to answer all incoming calls promptly, professionally, and compassionately.  We understand the patient, or family member, just had an ambulance transport, and it may have been traumatic.  The patient has received an invoice, statement or request for insurance information from their local fire department and has some budding questions or concerns.  Our staff is trained to understand and explain the complexity of the various insurances, fire district policies and levy programs set by each of our clients.   This enables us to properly address the needs of the patients--our goal is a satisfied patient.

Our incoming 800 number patient lines are answered Monday through Friday 8:00 a.m. to 8:00 p.m., and we have a Spanish-speaking translator on staff.  During off hours we have a voicemail system, and all messages left on the voicemail system are returned the next business day. 

To better assist our Spanish-speaking patients, we have composed an instruction letter in Spanish to be sent with Financial Assistance forms, which are also now available in Spanish. We are currently in the process of translating our insurance request forms as well.  This will be a great tool to help the patient fully understand the information needed by the fire districts. Our goal is to be able to process their financial assistance application and insurance request in a more efficient and timely matter.

Q. When an attorney requests records and asks that all records be released, must we comply and send all of the patient's medical records?
A. If the request was accompanied by the patient's authorization, review the authorization to determine what information the patient authorized for release. If the patient's authorization states that "any and all records" may be released, you still must apply minimum necessary criteria. Speak with the attorney to determine which records are needed and release only those records.
If a patient's authorization specifies release of a limited subset of records, you must comply with that authorization, even if the attorney requests more information.
If a subpoena seeking "any and all records" accompanies the attorney's request, you must apply minimum necessary criteria.

Perhaps you have heard from us in the past to be cautious of anyone requesting that your organization negotiate the payment of a claim.  On a daily basis, National Care Network, MultiPlan and/or Viant are trying to negotiate payment for your services.  These companies are contracted by commercial payers such as United Healthcare and Anthem to "expedite the processing of your claims by asking you to agree to the proposed allowable amounts (less patient liability) as payment for the services rendered".  This can reduce a claim by as much as 40%, which is unnecessary lost revenue to your organization.
At Systems Design, we are contacted daily by phone or fax from these organizations requesting a payment negotiation on a particular claim.  We immediately decline explaining we are dealing with public funds and negotiating public funds is not permitted. 
As a reminder to you and your staff - beware of this tactic.   Be on the lookout for faxes - attached are some samples received at our office.   There is no need to respond to these faxes received at your office.   In addition, should you be contacted by phone from anyone wishing to negotiate your claims, please decline or refer them to our office - we will gladly take care of this call for you!

Are EMS transport fees subject to B&O tax for public organizations?  When this question came up recently, we began researching the RCWs and WACs and also asking Systems Design's clients to chime in to develop some consensus regarding the issue.  The information we received and our own research led us to RCW 82.04.419 (exemption) and WAC 458-20-189. The consensus is that a public organization is considered exempt from B&O taxes if the program is funded less than 50% from user fees, which is true for most tax-supported EMS agencies that bill for their transport services.  Please consult your own tax advisors for further information. 

The proposed rule would grant patients the right to receive an "access report" telling them who accessed their protected health information over the previous three years. If this proposed rule goes into effect, any time an electronic health record is accessed by anyone at or outside the ambulance service, patients will have the right to know who requested the information. The accounting, recordkeeping and administration of this rule would be very difficult for much of the ambulance service industry. 
 
"From Page Wolfberg & Wirth"

Since this is a proposed rule, ambulance services, billing companies and others affected by the rule have an opportunity to send comments to HHS about it, and we strongly encourage you to do so. PWW already submitted a comment letter to HHS on behalf of the ambulance industry. PWW has also drafted a model comment letter that is now available. You may use the model comment letter to tell HHS about the heavy burden that this Rule would impose on your organization and to voice any additional concerns that you may have. To download the model comment letter and to view PWW's comment letter to HHS click HERE.

Systems Design and Official Payments Corporation (OPC) is offering an Online Credit Card Payment option to patients. Official Payments will create and maintain an online cart page with no upfront cost to Systems Design clients. We can print Visa, Mastercard, Amex and Discover logos, along with a personalized web address for the Systems Design/fire district web page on each statement we send to patients. By using the provided web page, a patient may go online and make a payment. There is no set-up or monthly maintenance cost for the service, but a 3.5% total transaction fee for processing does apply. This fee can be paid by the provider or by the patient as a convenience fee. If the patient pays the fee then OPC cannot offer Visa acceptance.

All of us at Systems Design were saddened to hear of Chief Matt Hadaller's passing on June 27th.  We had worked closely with him and the staff at Lewis County Fire District 3 for several years.  Our thoughts and sympathies go out to his family, friends, Lewis County Fire District 3 and all those who knew and respected him.  He was truly an innovator that deeply cared about the people he served with, and those he served.