Ask Billing Questions Here!

Brandon O

Brandon O

Puzzled by facies
1,718
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Speaking of which, which insurances will pay for additional personnel or other extras for bariatric patients? Or for waiting time on a wait-and-return transfer?

Also: will some insurers refuse to pay, or partially pay, for a longer emergency transport if a patient requested it? Stable patient, we bypass a nearer hospital because they wanted to go elsewhere?
 
OP
OP
B

BillingSpecialist

Certified Ambulance Coder
115
27
28
Brandon Oto said:
Speaking of which, which insurances will pay for additional personnel or other extras for bariatric patients? Or for waiting time on a wait-and-return transfer?

Also: will some insurers refuse to pay, or partially pay, for a longer emergency transport if a patient requested it? Stable patient, we bypass a nearer hospital because they wanted to go elsewhere?
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Medicare and most state Medicaid's (including the HMO Plans) will not pay for the extra stuff. Alot of private insurances will pay for some of them, like Blue Cross, Aetna, Cigna, United Healthcare. Then all your auto policies will cover them, as long a pt has med pay. It's really a trial & error or some investigation on the carrier

Insurance carriers will partially pay for the the long trips, that are at the patient's request. I have seen some of them get paid, but they were fully paid because the patient filed the appeal.
 
Aidey

Aidey

Community Leader Emeritus
4,800
11
38
But Medicare/Medicaid generally do not pay for the extended trips, correct?
 
JPINFV

JPINFV

Gadfly
12,681
197
63
...and here's an interesting question. Since you can't balance bill medicare/caid, would that be sufficient reason to refuse a request to a further facility? Alternatively, does Medicare/caid allow balanced billing of uncovered benefits?
 
OP
OP
B

BillingSpecialist

Certified Ambulance Coder
115
27
28
When a patient is requesting to go to a further facility, you need to let them know that the insurance will not cover the trip if they do not go to the closest facility, then you make them sing off on it (like an ABN). They sign off excepting responsibility for the trip that they were informed would not be covered.

Medicare will allow you to balance bill for what's not covered, but each Medicaid is different as they are a state by state carrier. You would have to check with your state Medicaid on that to be sure.
 
Brandon O

Brandon O

Puzzled by facies
1,718
337
83
Can you remark on any ongoing and planned changes to reimbursement as part of the Affordable Care Act?
 
OP
OP
B

BillingSpecialist

Certified Ambulance Coder
115
27
28
I don't believe there are any planned changes to reimbursement at this time. But I do believe there will be. With this ACA, all people will eventually have health insurance. I believe that there will be a decrease seen in your revenue, eventually!

There is a penalty that employers will have to pay if they do not offer healthcare to their employees, but in most cases that penalty is far much less than the premiums they have to pay. Therefore....employers will pay the penalty and force the employees to take the "Government" Insurance, which will more than like have reimbursements along the same lines as your state Medicaid reimbursements.

So the people who don't have insurance currently, will finally have something to pay their bills, but the other dropping to the "Government" Insurance will decrease your income.

But.....these are my personal thoughts and opinions :)
 
OP
OP
B

BillingSpecialist

Certified Ambulance Coder
115
27
28
Good Morning All!!

Just wondering if anyone has any questions!?

Hope everyone had a good 4th of July Holiday and that everyone has a good week! :D
 
Sandog

Sandog

Forum Asst. Chief
914
1
0
How can you reduce the insurance rates on the ambulance fleet. The rates are killing us.
 
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Aprz

The New Beach Medic
3,031
664
113
Does having a copy of the patient's driver license, passport, or other identification help with billing? Does having a copy of their insurance card help with billing?

I want to push the DNR thing because I am perplexed by something I see in the field. I was taught at my previous company to get a copy of the DNR to attach to my PCR. I was taught by current company to do the same. I am wondering why is a copy of the DNR useful? I thought it had something to do with billing.

Is there a website with a list of reason they should be transported by ambulance? I don't feel like the 10 presumptive medicare criteria cover it. Like we were just talking in the chatroom how supervision is a reason they should go by ambulance, like if the patient has dementia or Alzheimer's disease, and they are being discharged to a skilled nursing facility, wouldn't putting "requires ambulance because require supervision, history of dementia and Alzheimer's disease, oriented only to person" for example be good enough reason to transport by ambulance?

I noticed that CMS means Center for Medicare & Medicaid Services. I was never taught to get a Physician Certification Statement (PCS) for Medicaid. Does Medicaid have the same rules as Medicare?

Is there any information that's useful to include that helps with getting reimbursement from other insurances eg Blue Shield that isn't required by Medicare?

If I didn't say it already, thank you for answering our billing questions. I feel like billing is a very important part of the care report that people often don't care about, and leave out, and I feel some of it is pretty complicated.
 
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OP
OP
B

BillingSpecialist

Certified Ambulance Coder
115
27
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First I want to apologize for just now getting back to you. I didn't see the notification come in that someone had posted something, and I just happened to hop on and check on it.

Having a copy of a patient's driver's license or passport, would help with the verification of the spelling of a patient's name or making sure you have the correct mailing address. A copy of the insurance card is VERY helpful in billing, there are times that you are asked to send a copy of the insurance card along with a claim. As we know though, these documents are not always available, but when they are, I strongly encourage you getting them.

A DNR is always a good document to have just due to the type of work you do in this field. That way you cover yourself. For example, you transport a patient and you don't resuscitate them, the family throws a fit (because they didn't know they patient had a DNR), you have the documentation to back yourself up. As for needing it for billing, no I don't see it necessary. All my years in billing and I've never seen a need for it in the billing aspect.

I don't know of an actual website that would list out those reasons. The term "Medically Necessary" is defined differently by each individual. When reading a run I always put myself in that patient's position "If I was this patient with a nose bleed would I REALLY need to go by ambulance?" "If I were this patient who is 90 years old & has been vomiting & diarrhea for 48 hours would I REALLY need to go by ambulance?" If I answer "Yes" then I have to pull together to documentation to prove that it was Medially Necessary to the insurance company, who ever they may be. Medicare guidelines are always good to go by, as many insurances follow Medicare guidelines as well, but if you go a little off of those, as long as you've got good documentation to prove your right you should be okay. And even if you are submitting all the correct diagnosis, narrative, and additional documentation, you may still get a denial (which does happen from time to time), but if you feel confident that it was indeed Medically Necessary...don't give up on it...appeal appeal appeal!

I would get into the habit of getting a PCS for EVERY NON-EMERGENCY trip you take, no matter what the insurance is. Those non-emergency transports are the ones that will most likely get denied, and that is ALWAYS an excellent document to have on file! Medicaid's differ state by state, you will have to get on your state's Medicaid site and look up their requirements. Those state Medicaid's can be a pain in the butt and they're usually not worth any of it...cause most of them don't reimburse for crap!

The keys to billing are to diagnosis as much as possible (ICD9 Codes), always include a narrative (with information that you aren't able to get an ICD9 code for, ex:poss MI, list out equipment used or medications administered, ex: EKG, IV, Nitro), make sure your crew is documenting everything. I know they hate it, but it's got to be done. It's a waterfall effect....if they aren't documenting correctly, then the company is getting paid, which is in turn going to result in them not getting paid! Something else that you need to consider in billing private/commercial insurances like BCBS, Cigna, Aetna, Auto Insurances, Worker's Comp...ect, is that there are things that Medicare considers "Bundled" that you aren't aloud to bill them for, you can bill the private/commercial insurance for. Examples, BLS Disp Supplies, ALS Disp Supplies, IV, Oxygen, Pulse Ox, C-Collar...ect.

And you are VERY welcome for the answers to the billing questions. You are correct that billing is very important & can be very complicated. I started this thread because I thought it would be a good place for people to come ask a question and get an answer or suggestions. And the thread has turned out to be much more of a success than I thought it would be :) I may not know all the answers, but with enough information, I can find it or direct you to where to start. And if I don't know, I'm not afraid to say so. Thank you for the opportunity! If you need some more help, please let me know!
 
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Aprz

The New Beach Medic
3,031
664
113
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unleashedfury

Forum Asst. Chief
729
3
0
What does one have to do to learn billing? I mean is there a certification or degree requirement?

I look at it this way, I am not gonna be a youngin forever. and if it means I end up in the back office do admin or billing. I'd be ok with that. That and I am a information guru I love to learn new things so learning the billing aspect of my job would be cool
 
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Aprz

The New Beach Medic
3,031
664
113
Not sure if you're still around. I don't really mind if anyone answers this.

I was wondering if the patient's social security number, height, and weight is at all useful for billing? If so, how so?
 
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CodeBru1984

EMT
990
324
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Aprz said:
Not sure if you're still around. I don't really mind if anyone answers this.

I was wondering if the patient's social security number, height, and weight is at all useful for billing? If so, how so?
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I don't usually ask for the patient's social security number when filling out paperwork, as it is normally on the face sheet provided by the hospital.
 
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Aprz

The New Beach Medic
3,031
664
113
CodeBru1984 said:
I don't usually ask for the patient's social security number when filling out paperwork, as it is normally on the face sheet provided by the hospital.
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I rarely see it on any of the hospital facesheets here.
 
Sublime

Sublime

LP, RN
264
6
18
Question: Do you know if a patient signing an AMA form has negative effects for them in terms of insurance reimbursement?

For instance, we had a patient who had a seizure contemplate signing our AMA form but instead decided to be transported after saying "Nevermind last time this happened it showed up I went AMA and the insurance wouldn't pay because of it". I am not sure exactly what she meant by that but I am curious if you know anything about it.
 
chaz90

chaz90

Community Leader
Community Leader
2,735
1,272
113
Sublime said:
Question: Do you know if a patient signing an AMA form has negative effects for them in terms of insurance reimbursement?

For instance, we had a patient who had a seizure contemplate signing our AMA form but instead decided to be transported after saying "Nevermind last time this happened it showed up I went AMA and the insurance wouldn't pay because of it". I am not sure exactly what she meant by that but I am curious if you know anything about it.
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We used to run on a frequent flyer diabetic. My old service charged for "Treat no transport," and his insurance would only pay if we transported. We'd wake him up on scene every time, transport him to the hospital, then transport him back 30 minutes later. The insurance happily paid the $700 transport fee plus the hospital bill rather than the $100 treat no transport fee time after time. I believe that was able to be changed eventually, but it was an absurd cycle for a while.
 
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