July 2012

NEWSLETTER

 A Word about Systems Design's

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Scheduled Non-Emergency Medicare Audit Results

Medicare conducts ongoing reviews and audits to ensure that payment is made only for those medical services that are reasonable and necessary. After data analysis, Medical Review verifies if billing problems exist and validates provider compliance with Medicare coverage as well as coding and billing guidelines.

Systems Design recently responded on behalf of a number of our clients to an audit which focused on scheduled non-emergency (A0428) transports, such as those for dialysis or radiation appointments.  We were required to provide trip notes, Physician Certifications, and any other pertinent documentation for numerous claims selected by Medicare. The results have been published, and we are proud to say that Washington (home of our clients whose claims were reviewed) scored considerably higher than any of the nine other states represented in the survey. Medicare states the audit file will be reviewed at least quarterly, and those providers with low or no errors after a reasonable sample will no longer be reviewed. After the initial sample, none of our clients were scheduled for additional review.

We would like to thank our clients who provide scheduled non-emergency transports for continuing to thoroughly document that these trips are reasonable and medically necessary, and we vow to continue doing our part by submitting all your claims accurately and compliantly.

To view the link to the survey, click  HERE 

 Patient Signature

When it comes to maximizing revenue, one of the most important requirements for claim submission is a patient signature.  Without a signature from the patient, many types of insurance cannot be compliantly billed. This is especially true of patients with Medicare or Medicare replacement plans.

Getting a signature from the patient at the time of the transport is always best and should be done without fail when possible. However, when the patient is unable to sign because of a mental or physical condition, the following types of representatives can sign on their behalf: a relative, a legal guardian, or a caregiver from another agency such as the hospital, hospice or nursing home.  Documentation must include how the signer is related to the patient and the reason the patient cannot sign.

If no representative is available or willing to sign, a crewmember present during the transport should sign a statement explaining why the patient and representatives were not able to sign and include the date and time of transport, name of receiving facility and a hospital face sheet.
Systems Design makes every effort to obtain a signature from patients who have been transported without signing, but by far the best method is to collect the signature from either the patient or his/her representative at the time of the transport. You will be rewarded for your effort with not only increased revenue, but significantly faster payment of claims.

For a copy of the latest PWW Ambulance Patient Signature form, version 2.0 click HERE.

Should you have questions regarding patient signature rules and regulations, please contact our Compliance Department at 360.394.7024.

EMT Signatures

It's been about two years since Medicare began requiring the patient care report (PCR) to include an EMT signature.  PCRs are sent to Medicare for all audit requests and when appealing a denied claim.  Unsigned PCRs are not considered "official" and those claims are denied.

The number of PCRs with valid EMT signatures has greatly increased over these last two years.  We appreciate all your efforts to train crews, develop signature logs and respond to our requests for PCRs with signatures.  This directly improves your collection rate.

If you are unfamiliar with the signature rules, or if it's time for a refresher, the following is part of an article from our February 2011 newsletter:

"Here is what the law requires-any medical services 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:
  
  

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."

5010 Update

In previous newsletters and web-blasts we have discussed revenue inconsistencies due to the 5010 software conversions at Medicare, Medicaid, insurance companies and clearinghouses.  Fortunately, the problems seem to be dissolving, and the backlogs are being cleared. We are seeing more consistent payments and are very pleased to note that many of our clients' overall revenues have recovered, or are recovering, from shortfalls in the first and second quarters of 2012. 

Although the situation seems to be normalizing, we remain highly vigilant in our monitoring of claims response and are focusing on our clients' Accounts Receivables.

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