FAQ
Proven, Expert Partners
EMS & Ambulance Billing and Claims Solutions
Q: The AccuMed Group makes many references to compliance. What are the common mistakes you see from ambulance companies that do their own billing?
Common errors include:
- Assignment of incorrect procedure codes (up coding and down coding)
- Improper use of ICD-10 and Condition Codes
- Improper use of Modifiers, including not assigning a GY modifier when the trip does not support medical necessity in the documentation
- Improper mileage use
- Failure to bill properly when processing MVA incidents
- It is a common practice for payors to extrapolate an error rate and apply that to total billable run volume. In the case of a 23% error rate applied to 5,000 annual trips, the payor will likely seek recovery of 1,150 trips, for multiple years plus interest.
Q: What is involved for us to make the switch to The AccuMed Group?
The AccuMed Group’s Customer Service Department will present you with all the forms and applications necessary to convey billing operations to The AccuMed Group, sparing you the time and challenges of the enrollment process. At the same time, we will engage in pre-dispatch consultation to ensure all Customer’s policies, procedures, charges and the like are positioned to optimize compliant revenue. Pre-dispatch consultation services include:
- Initial on-site incident documentation training (how to develop a compliant incident report that maximizes recovery).
- Ongoing incident report documentation review and training.
- Establishment/analysis of:
- Collection Policy
- Incarcerated Patient Policy
- Compliance Plan
- HIPPA Privacy Plan
- Intercept Agreements
- Hardship Policy
- Charge & reimbursement analysis to optimize revenue.
- Compliance reviews (Internal and External).
- Review, analysis and recommendations regarding contractual relationships with third party payers.
- Reasonable cost-free access to the national EMS law firm of Page, Wolfberg and Wirth, LLC.
- Support of the annual budget process.
- Reporting and monitoring tools.
- Technology – electronic data management support.
Q: Does The AccuMed Group only support ESO software?
Q: Does The AccuMed Group include ePCR software or hardware costs within the fee?
Q: Does The AccuMed Group provide assistance with determining the proper amount to bill insurance companies?
Q: Does The AccuMed Group recommend HIPAA policies / plan for clients?
Q: How often will we receive billing / financial reports? How do we receive them?
Q: Is it cheaper for us to outsource billing or do our billing in-house?
Q: Does your company outsource any of your billing process?
Q: Do you use any collection agencies?
Q: How do we send you runs to bill?
Q: Who do our patients call if they have any questions?
Q: Do you bill insurance and patients?
Q: Does The AccuMed Group bill for fire services?
Q: How much do you usually collect, what is your collection percentage?
EMS System A | EMS System B | |
---|---|---|
Annual Trips | 4,615 | 4,615 |
Annual Gross Charges | $3,000,000.00 | $2,500,000.00 |
Annual Payments | $1,950,000.00 | $1,700,000.00 |
Contractual W/O’s | $350,000.00 | $175,000.00 |
Gross Recovery | 65% | 68% |
Net Recovery | 76.66% | 75% |
Under this example, with the same number of billable trips, EMS System A deposited $250,000.00 more than EMS System B, yet EMS System B had a better gross collection rate. EMS System A average recovery per trip is $422.53 and EMS System B average recovery per trip is $368.36. In this case study, presuming payor mix, billing and data capture effectiveness is similar, fee schedules are the differentiator.
The AccuMed Group ’s low to high recovery per run range is $109.89 – $846.55.
Variables that influence recovery rates:
- Incident Report Development and Delivery Method (Manual vs. Electronic Data Capture)
- Incident Report Documentation Quality
- Establishment of Medical Necessity (complete description of all procedures, medications, patient assessments, outcomes regarding what was “seen and done” during the entire incident)
- Complete and accurate demographic and insurance information captured
- Legibility
- Quality assurance procedures completed prior to delivery of the incident for billing (identification and completion of missing, inaccurate or incomplete incident report and supplemental forms data)
- Incident report delivery times
- Signatures
- Complete and accurate supplemental forms (Physician Certification Statement, Advanced Beneficiary Notice)
- Collection Policies
- Overall charge strategy
- Resident vs. non- resident billing strategy
- Hardship criteria – third party debt collection utilization
- Acceptance of credit card payments
- Unique contractual agreements
- Payment obligations conveyed from EMS staff to patient (establishment of expectations / requirements)
- Evolving Community Demographics and Payor Mix
Q: Has The AccuMed Group had any billing violations?
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