Maggie Adams is an expert on billing. Managing consultant at PWW Consulting, Inc. (sister organization of Page, Wolfberg & Wirth) and president of EMS Financial Services for many years, she is a graduate of the Wharton School of Business. Adams recently spoke with EMS Magazine's Associate Editor Kathryn Robyn on billing and reimbursement issues of concern to EMS agencies.
EMS: How can agencies improve their billing process?
MA: Getting the bill out the door every week is a challenge, so keeping on top of daily billing is first and foremost. There are software programs that will generate bills and help EMS agencies keep on track, but the environment that they bill in is highly regulated. There's Medicare and Medicaid and that spills over to commercial insurance, as well. So, agencies have to make sure they get good documentation from their field crews. They need a compliant document to work with in order to create a compliant bill.
EMS: What is a "compliant document"?
MA: The field crews prepare the client document that the billers use to create a bill. The better the documentation on the trip report, the better document the billing department will have. The billing department has to ensure that what's documented meets the standards of medical necessity-as part of the regulatory world that the billing is done in. An ambulance won't be paid for services unless it was medically necessary for the patient to have them. In order for the billing department to be able to create a good bill that will meet the standards of compliance for Medicare and Medicaid, they have to have good documentation to start with.
EMS: What will help them do that?
MA: Field and billing personnel need ongoing training so that compliance can be maintained. Being trained in coding and compliance and doing things the right way helps improve cash flow. It's quicker to process, and it turns around quicker at the payer end. Coding and compliance can be tough to learn, but once people are trained in them, and if training is ongoing, then compliance is maintained and cash flows smoothly.
EMS: Then what?
MA: Don't lose sight of bills that already went out the door-what went out last week, what went out last month, what went out two months ago-that have yet to be paid. You cannot overlook the subject of follow-up: Follow-up on claims with Medicare, Medicaid and commercial payers that there's a problem with-they might need to be resubmitted, or they might have been denied-as well as with patients who did not pay.
EMS: What's a good plan for following up on bills?
MA: Set aside time every week to follow up on bills. Consistency is key to success. Consistently setting aside time every Wednesday afternoon or Thursday to follow up on unpaid bills can shake a lot of cash loose from the trees.
EMS: How do you resubmit claims that have been rejected?
MA: It depends on the insurer and what they will allow you to do. One insurer will answer a question about claims on the phone. Another might have an e-mail or a fax system you can use. Others will let you do it online. Start with Medicare, because that's usually where the bulk of claims are, maybe 35%-40%. Then pursue those insurers that have most of your other claims. There are always a couple of insurance companies that dominate the process, whether it's Blue Cross, Aetna, Kaiser-Permanente or whoever.
One of the most frustrating problems for ambulance providers is claims get sent out and nobody knows what happens to them. You can try resubmitting it, but you might find out the insurance company wants the trip report documentation to substantiate the nature of the claim; however, they haven't asked for it, so it takes the ambulance company investigating what's going on. I recommend doing that in 30-60 days, because the longer a bill sits there, the more likely it is to get lost in the process-the older a claim is, the harder it is to get paid.