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?
A: Overall, when The AccuMed Group conducts compliance reviews on behalf of perspective customers, we find a 23% average error rate. This is significant and rarely attributable to a single issue. 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?
A: Our experience on-boarding over 200 EMS Customers will ensure your switch to The AccuMed Group will be efficient and preserve cash flow, while minimizing Customer involvement. 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?
A: No, while we have an excellent relationship with ESO, The AccuMed Group is vendor-neutral in our approach and we will work with all ePCR vendors.
Q: Does The AccuMed Group include ePCR software or hardware costs within the fee?
A: The AccuMed Group will support and fund any NEMSIS compliant ePCR application and in some instances, mobile hardware to host ePCR applications. The AccuMed Group Customers will receive the most competitive pricing when the Customer delivers a NEMSIS compliant data set with named and embedded attachments to The AccuMed Group’s FTP server on a weekly basis.
Q: Does The AccuMed Group provide assistance with determining the proper amount to bill insurance companies?
A: Yes. The AccuMed Group’s Customer Service Department will make recommendations to optimize compliant revenue initially through the pre-dispatch consultation process and thereafter through the life of the contract.
Q: Does The AccuMed Group recommend HIPAA policies / plan for clients?
A: Yes, The AccuMed Group provides resources and guidance to assist our Customers in achieving compliance with all regulatory entities. In addition, we host cost free quarterly webinars through the EMS Law firm of Page, Wolfberg & Wirth, LLC to keep our Customers appraised in cutting edge industry news and information.
Q: How often will we receive billing / financial reports? How do we receive them?
A: The AccuMed Group recommends delivery of financial reports on a monthly basis. However, we will customize reporting configurations, delivery times and methods to meet the individual needs of each customer we serve.
Q: Is it cheaper for us to outsource billing or do our billing in-house?
A: The cost of full compliance is difficult to quantify. We believe the compliance climate is such that in-house billing operations, if properly staffed and resourced, are not cost effective compared to volume based EMS Medical Claims Management solutions such as The AccuMed Group. In addition, the overwhelming majority of the time, The AccuMed Group is able to improve overall recovery for customers that previously conducted in-house billing.
Q: Does your company outsource any of your billing process?
A: No. The AccuMed Group conducts all operations through our professional billers from three strategically located Michigan offices.
Q: Do you use any collection agencies?
A: Yes. The AccuMed Group routinely works with third party debt collection agencies once we exhaust all internal efforts. It is important to note that The AccuMed Group employs all the same resources as a third party debt collection agency. The result – The AccuMed Group collects the majority of all self-pay receivables at a much lower cost point than a third party debt collection agency. Nonetheless, we do suggest moving uncollected self-pay receivables to a third party debt collection solution that specializes in medical debt collection.
Q: How do we send you runs to bill?
A: The best practice is to upload incidents to our secure FTP server. We also have many automated secure processes with ePCR vendors to push and pull data.
Q: Who do our patients call if they have any questions?
A: The AccuMed Group maintains a standalone patient Account Services Department tasked with the sole responsibility of engaging in professional and timely communication with the patients you serve. Our caring staff will at all times uphold the principles and integrity of your service. We pride ourselves on acting as an extension of your service.
Q: Do you bill insurance and patients?
A: Yes. The AccuMed Group will manage each and every billable incident. We make every effort to identify and bill all known insurance sources prior to involving the patient. Once all insurance sources have been exhausted the balance is transferred to the patient, when permitted by law or contractual agreement.
Q: Does The AccuMed Group bill for fire services?
A: Yes. The ability to seek reimbursement for fire related incidents varies from state to state. Cost recovery for fire incidents is a common method to offset cost associated with fire operations.
Q: How much do you usually collect, what is your collection percentage?
A: With respect to “collection rates” – bottom line, one primary Key Performance Indicator (KPI) works best; the greater the average recovery per run, the better. The concept of net and gross collection rates for benchmarking is flawed. The following example illustrates why net and gross collection measurements are deceptive:
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:
|EMS System A||EMS System B|
|Annual Gross Charges||$3,000,000.00||$2,500,000.00|
- 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
- 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
- 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?
A: No. The AccuMed Group maintains a perfect record of zero billing violations since our 1989 incorporation.
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