Ask Your Billing Questions Here!

[BillingSpecialist]

Hello all!!

If you have billing questions you'd like to ask or maybe things you'd just like to know. Please ask them here. I am a Certified Ambulance Coder and have been doing billing for going on 15 years now. I would like to help anyone out who has a question

 

[Flying]

Hey welcome back.

What are most common omissions in EMS documentation that send a bill through the 90 day death cycle?

 

[BillingSpecialist]

One of the most common things is answering the questions "Why did the patient have to be transported by ambulance? What made it impossible for them to go by private vehicle?" Other things are just stating the patient has "pain." Okay, Where is the pain? What does patient rate the pain at on a 1-10 scale? Or that the patient "fell." Okay, How did they fall? Where did they fall at? Did they hit anything when they fell?

Insurance carriers are coming down hard on the documentation. If it's not stated on your run report it didn't happen. If what's on the medical necessity isn't documented on your run as well, the medical necessity doesn't do you very much good.

 

[Gurby]

I have been super lazy about getting patient signatures on things. I have been getting receiving facility RN signature, and then saying patient unable to sign due to "patient condition". How does this affect the billing side of things?

How much work do I create for the billing department by not retrieving insurance information after a 911 call? Is it helpful at all for me to get a blank hospital demographics sheet for the patient (with name, incident number, but none of the other info), so you can look them up later? How does that process work, anyways?

 

[BillingSpecialist]

The patient signatures are very important to the billing side of things. Then receiving facility should only be signing if the patient is unable to sign, and they should be putting something more specific in there than "patient condition." Examples of something they should be putting is confusion, poss fractured arm, unconscious, demntia.....reasons that make the patient unable to sign. Along with the receiving facility signature are you or the crew also signing off on that as well? Because if you are not, you should be. If no signature is obtained from the patient or the receiving facility, then the billing company is not able to bill that claim to the insurance compnay until a signature is obtained. So the billing compnay should be sending out a signature form to the patient to sign, waiting for the patient to return it, before that claim is even billable. This process does delay the payment on the run, and we also all know how patient's like to respond to anything the receive in the mail LOL!!

If you have not received the insurance infomation after a 911 call, it creates additional work for the billing office, but sometimes it just can't be avoided. The hospital sheet is extremely helpful, but not if it's blank. And every billing department has differnt process but I can tell you how our office handles those kind sof things. When we received a run with no insurance information on it, the first thing we do is check to see if they have Medicaid, we can check eligibility electronically, and/or if the patient is of Medicare age we will check that as well. If there is no insurance found we will contact the hospital that patient was transported to or from & get the information that they have on file. If there is no luck there a special form is sent to the patient letting them know that we have no insurance listed for them & that they need to return it so we can get their insurance billed. lf we do not hear from that patient, we will then call them.

 

[teedubbyaw]

Can you pay my bills?

 

[BillingSpecialist]

Can you pay my bills?

Unfortunately I can not

 

[Gurby]

The patient signatures are very important to the billing side of things. Then receiving facility should only be signing if the patient is unable to sign, and they should be putting something more specific in there than "patient condition." Examples of something they should be putting is confusion, poss fractured arm, unconscious, demntia.....reasons that make the patient unable to sign. Along with the receiving facility signature are you or the crew also signing off on that as well? Because if you are not, you should be. If no signature is obtained from the patient or the receiving facility, then the billing company is not able to bill that claim to the insurance compnay until a signature is obtained. So the billing compnay should be sending out a signature form to the patient to sign, waiting for the patient to return it, before that claim is even billable. This process does delay the payment on the run, and we also all know how patient's like to respond to anything the receive in the mail LOL!!

If you have not received the insurance infomation after a 911 call, it creates additional work for the billing office, but sometimes it just can't be avoided. The hospital sheet is extremely helpful, but not if it's blank. And every billing department has differnt process but I can tell you how our office handles those kind sof things. When we received a run with no insurance information on it, the first thing we do is check to see if they have Medicaid, we can check eligibility electronically, and/or if the patient is of Medicare age we will check that as well. If there is no insurance found we will contact the hospital that patient was transported to or from & get the information that they have on file. If there is no luck there a special form is sent to the patient letting them know that we have no insurance listed for them & that they need to return it so we can get their insurance billed. lf we do not hear from that patient, we will then call them.

Regarding getting patient signatures, I guess it just makes me feel grimy... The thing we have them sign basically says, "I authorize you to bill my insurance, and I agree to pay the balance if there is any portion that my insurance won't cover". I feel bad because I think patients probably don't fully understand what I'm asking them to sign, and I feel awkward fully explaining it to them. So for that reason, I had been getting a facility representative signature (along with EMS crew signature). Based on what our PCR fine print says, this should authorize billing insurance, but doesn't trick the patient into agreeing to pay if insurance doesn't cover it. Thoughts?

Thanks so much for you insight, this is really helpful!

 

[teedubbyaw]

Regarding getting patient signatures, I guess it just makes me feel grimy... The thing we have them sign basically says, "I authorize you to bill my insurance, and I agree to pay the balance if there is any portion that my insurance won't cover". I feel bad because I think patients probably don't fully understand what I'm asking them to sign, and I feel awkward fully explaining it to them. So for that reason, I had been getting a facility representative signature (along with EMS crew signature). Based on what our PCR fine print says, this should authorize billing insurance, but doesn't trick the patient into agreeing to pay if insurance doesn't cover it. Thoughts?

Thanks so much for you insight, this is really helpful!

"I need a signature. This is for insurance and billing; feel free to read it and hit accept"

 

[BillingSpecialist]

Regarding getting patient signatures, I guess it just makes me feel grimy... The thing we have them sign basically says, "I authorize you to bill my insurance, and I agree to pay the balance if there is any portion that my insurance won't cover". I feel bad because I think patients probably don't fully understand what I'm asking them to sign, and I feel awkward fully explaining it to them. So for that reason, I had been getting a facility representative signature (along with EMS crew signature). Based on what our PCR fine print says, this should authorize billing insurance, but doesn't trick the patient into agreeing to pay if insurance doesn't cover it. Thoughts?

Thanks so much for you insight, this is really helpful!

It can be something hard to explain to a patient, especially if the patient is elderly. But it's one of those things that have to be done. The patient should always be the one signing unless they are physically incapable of doing so. And yes a receiving facility & crew signature would allow you to bill the insurance, but that signature section should be only used if the patient can't sign. If my billing office received one that just said "patient condition," we would not take that & would send a form out to the patient to sign that states the same thing you would have them sign in the field. Talking about money & financial stuff is never an easy conversation to have with someone, but it's really something that needs to be done and be done correctly to protect yourself and the squad you work for.

Hope this is helpful

 

[Gurby]

It can be something hard to explain to a patient, especially if the patient is elderly. But it's one of those things that have to be done. The patient should always be the one signing unless they are physically incapable of doing so. And yes a receiving facility & crew signature would allow you to bill the insurance, but that signature section should be only used if the patient can't sign. If my billing office received one that just said "patient condition," we would not take that & would send a form out to the patient to sign that states the same thing you would have them sign in the field. Talking about money & financial stuff is never an easy conversation to have with someone, but it's really something that needs to be done and be done correctly to protect yourself and the squad you work for.

Hope this is helpful

Sigh... I guess I will change my ways, and start getting more patient signatures. Thanks for your help!

 

[BillingSpecialist]

Sigh... I guess I will change my ways, and start getting more patient signatures. Thanks for your help!

That's a good idea! And you're welcome!

 

[akflightmedic]

Another one converted to The Dark Side...

 

[RedAirplane]

I love that we don't bill. (Although unfortunately the ALS will).

It always brings a smile to someone when they try to hand you an insurance card and we tell them we don't collect from patients.

 

[TreySpooner65]

Is it true that Medicare and or Medical (if you're familiar with it) do not allow a provider to bill any unpaid portion of a bill to the patient?

 

[BillingSpecialist]

Is it true that Medicare and or Medical (if you're familiar with it) do not allow a provider to bill any unpaid portion of a bill to the patient?

It depends on how Medicare process a claim. If they pay it, then there's always a portion that's billable to the patient or their secondary insurance. If they deny it,, there's a possibility they could deny it with a code that doesn't allow you to bill the patient.

But MediCal, or any state Medicaid, will not allow you to balance bill the patient. What they don't pay must be written off.

 

[TreySpooner65]

It depends on how Medicare process a claim. If they pay it, then there's always a portion that's billable to the patient or their secondary insurance. If they deny it,, there's a possibility they could deny it with a code that doesn't allow you to bill the patient.

But MediCal, or any state Medicaid, will not allow you to balance bill the patient. What they don't pay must be written off.

Thank you!

 

[BillingSpecialist]

Thank you!

You're very welcome

 

[BillingSpecialist]

Anyone have any questions?

Hope everyone is surviving Storm Jonas. I'm sure it has kept you all very busy

 

[Gurby]

I've been getting patient signatures left and right like a good doobie.