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[Chris07]

We do the ALS transports for them also, the fire medic simply hops in the back of our ambulance with his gear and we transport ALS that way (documented as such) so I'm pretty sure we'll bill for ALS as well

I believe the private transport company pays the difference from the ALS rate to the FD, meaning county fire only gets paid for ALS calls they ride in with. I'm sure they pay the difference between the BLS rate and the ALS rate to county fire so the private transport company is making the BLS rate on every transport and any difference due to the call being ALS goes to county fire. That's what I've heard anyways. It seems to make the most sense.

 

[TreySpooner65]

I believe the private transport company pays the difference from the ALS rate to the FD, meaning county fire only gets paid for ALS calls they ride in with. I'm sure they pay the difference between the BLS rate and the ALS rate to county fire so the private transport company is making the BLS rate on every transport and any difference due to the call being ALS goes to county fire. That's what I've heard anyways. It seems to make the most sense.

That's the way I've understood it.

It was explained to me differently, but same end result.

I was told fire "bills" private ambulance for what ever the aggreded upon fee is, and ambulance collects the bill from the patient.

I was told this because apparently firefighters like to direct patient complaints towards the private emts saying "we don't bill you they do, take it out on them."

 

[BillingSpecialist]

That's the way I've understood it.

It was explained to me differently, but same end result.

I was told fire "bills" private ambulance for what ever the aggreded upon fee is, and ambulance collects the bill from the patient.

I was told this because apparently firefighters like to direct patient complaints towards the private emts saying "we don't bill you they do, take it out on them."

Yes, this is how things are usually handled, and you are right on your reasoning too

 

[RedAirplane]

We are a private company, contracted to the FD for transport since they choose not to do that themselves. County Fire does not bill. Not sure off the top of my head for the other 2 smaller departments (each a municipal city FD) we run with. In any case, any and all EMS calls with these 3 FDs will get an engine or truck company, and a rescue squad from the FD (meaning a dual FF/PM ALS unit typically in a heavy duty work truck that carries all their ALS supplies and a small selection of tools for rescues, through that's primarily the job of the engine company) and then we show up in the ambulance.

Engine = 4 people?
Rescue = 2 people?
Ambulance = 2 people?
Total = 8?

I'm all for sending all resources needed to a call, but this seems like an odd setup. Why does the fire department send an engine and a rescue? Usually I understand they send an engine to take care of things until the ambulance gets there. Is the engine somehow beating the rescue to scene? seems confusing.

Also, where does the money for two ALS apparatus per call come from if they don't bill and don't always transport with the ambulance?

 

[TreySpooner65]

Engine = 4 people?
Rescue = 2 people?
Ambulance = 2 people?
Total = 8?

I'm all for sending all resources needed to a call, but this seems like an odd setup. Why does the fire department send an engine and a rescue? Usually I understand they send an engine to take care of things until the ambulance gets there. Is the engine somehow beating the rescue to scene? seems confusing.

Also, where does the money for two ALS apparatus per call come from if they don't bill and don't always transport with the ambulance?

Yes. It's ridiculous. But its the SoCal way. The engines are not besting the rescues, they are usually from the same station.

Some departments have changed their "rescues" from pickup trucks to actual ambulances, the only difference is these "ambulances" are not permitted to transport.

That's right. A non transporting ALS ambulance, on scene with a BLS ambulance that transports. One paramedic from the "rescue" jumps on the BLS ambulance and they transport that way. I've seen this setup in several departments and its my belief that this is them preparing to bring transportation in-house, at least partially, when contracts are up.

Most departments however are still using the pickup trucks. The engines are also paramedic generally. I suppose the idea is, the engine is there to help, and go go back to the station while the pickup and the ambulance go to the hospital.

It's an incredibly inefficient system, because for every ALS patient holding the wall at the hospital, you have 2 EMTs and 2 Paramedics. One paramedic drives the pickup behind the ambulance to the hospital, usually code 3, because why not... Nothing else makes sense!

The reasoning is, that if the patient doesn't need a paramedic, then they can go BLS and the paramedic stays available for more calls. In reality, it doesn't really work.

As for payment, yes, they do charge, contrary to the previous statement. Initial base obviously comes from taxes, but if the fire department goes in with the ambulance, they bill the ambulance company, who then passes it on to the patient.

It's an awful system.

 

[Jim37F]

Engine = 4 people?
Rescue = 2 people?
Ambulance = 2 people?
Total = 8?

I'm all for sending all resources needed to a call, but this seems like an odd setup. Why does the fire department send an engine and a rescue? Usually I understand they send an engine to take care of things until the ambulance gets there. Is the engine somehow beating the rescue to scene? seems confusing.

Also, where does the money for two ALS apparatus per call come from if they don't bill and don't always transport with the ambulance?

Yeah, 7 or 8 people. Depending on the area if the squad is always busy then the engine will be first on most often and can and will cancel the incoming squad if the call will be BLS. IME usually they'll cut the engine loose once the ambulance is on scene. It is nice to always have the lift assist handy for non ambulatory patients (especially the heavier ones that are becoming more and more common), and anything traffic related it's def nice to have the engine play traffic shield lol.

 

[BillingSpecialist]

BillingSpecialist, could you ever put together a general "top ten" list of why EMS run insurance claims are denied? That would be really interesting to me.

After doing some research I've given you a "Top Five" list, and I have found that the majority of denials received on ambulance claims are:

5-Issues with ICD-10 codes
4-Non-Covered Benefits
3-No Patient Signatures
2-Medical Necessity Not Properly Completed or Illegible
1-Improper Documentation

#4--I don't really feel is a denial reason, there are often claims that we have to bill for a non-covered denial. For instance, a transport to a Doctor's Office, Medicare will not pay for those, but we have to have that type of denial in order to bill the secondary or the patient. And reason #5 is a billing/coding error, nothing the crews can do about that.

Something else that is causing more denials since January 1st, in areas where it's been implemented, is the prior authorizations required for repetitive non-emergency transports. If anyone wants more info on that you can let me know, but I know it's only impacting a few areas at this moment.

Hope this is helpful to you!

 

[TreySpooner65]

What modifications to patient signature rules are there for special circumstances? For example, a patient in custody, or a 5150? (Involuntary mental health hold) What about a patient who has a conservator? Are there any patients in the special situations catagory that do NOT need to sign, and more importantly, which patients in that catagory DO have to sign?

 

[BillingSpecialist]

What modifications to patient signature rules are there for special circumstances? For example, a patient in custody, or a 5150? (Involuntary mental health hold) What about a patient who has a conservator? Are there any patients in the special situations catagory that do NOT need to sign, and more importantly, which patients in that catagory DO have to sign?

The patient signatures that I have referred to is the signatures that give the authorization to bill.

With that being said, the allowance for special circumstances is that the receiving facility and crew, or the patient's POA can sign. If the patient is unable to sign, (examples: unstable mental state, unresponsive, dementia, poss fx of dominant arm, patient in police custody), a signature must be obtained by someone in order for the claim to be billed to the insurance. If the signature is not being obtained, that doesn't mean that it can't be billed at all, it just means the billing staff will have to obtain a signature from the patient before they can bill the claim. And that's why it's important to get that signature when the crew is in the presence of the patient, because we all know how patient's like to respond to things they receive in the mail.

The ONLY transport of a patient that you don't need a signature for, is the transport of a deceased patient.

 

[TreySpooner65]

The patient signatures that I have referred to is the signatures that give the authorization to bill.

With that being said, the allowance for special circumstances is that the receiving facility and crew, or the patient's POA can sign. If the patient is unable to sign, (examples: unstable mental state, unresponsive, dementia, poss fx of dominant arm, patient in police custody), a signature must be obtained by someone in order for the claim to be billed to the insurance. If the signature is not being obtained, that doesn't mean that it can't be billed at all, it just means the billing staff will have to obtain a signature from the patient before they can bill the claim. And that's why it's important to get that signature when the crew is in the presence of the patient, because we all know how patient's like to respond to things they receive in the mail.

The ONLY transport of a patient that you don't need a signature for, is the transport of a deceased patient.

I don't transport dead people [emoji28]

 

[BillingSpecialist]

I don't transport dead people [emoji28]

LOL!!

There are runs that can be billed for a deceased patient. If you were dispatched prior to the patients pronounced time of death, then you are able to bill a loading fee with a special modifier and get reimbursement for it. So in situations like those.....you would not need a signature from anyone to be able to bill that.

 

[rails]

After doing some research I've given you a "Top Five" list, and I have found that the majority of denials received on ambulance claims are:

5-Issues with ICD-10 codes
4-Non-Covered Benefits
3-No Patient Signatures
2-Medical Necessity Not Properly Completed or Illegible
1-Improper Documentation

#4--I don't really feel is a denial reason, there are often claims that we have to bill for a non-covered denial. For instance, a transport to a Doctor's Office, Medicare will not pay for those, but we have to have that type of denial in order to bill the secondary or the patient. And reason #5 is a billing/coding error, nothing the crews can do about that.

Something else that is causing more denials since January 1st, in areas where it's been implemented, is the prior authorizations required for repetitive non-emergency transports. If anyone wants more info on that you can let me know, but I know it's only impacting a few areas at this moment.

Hope this is helpful to you!

Very helpful, thanks! Are reasons #1 and #2 pretty similar? Or is "Improper Documentation" more related to improperly documenting the chief complaint, patient condition, etc.?

 

[BillingSpecialist]

Very helpful, thanks! Are reasons #1 and #2 pretty similar? Or is "Improper Documentation" more related to improperly documenting the chief complaint, patient condition, etc.?

They are similar in some ways, it all results back to documentation.

2-Medical necessity not being completely filled out, or the hand writing not legible. It's important on those as well for who ever signs it to write their name out as well. There should be a line on the medical necessity for them to print their name as well as sing it.

1-Improper documentation is relating to the chief complaint, patient condition, ect, and there being a lack of information in that area. Also if there is a medical necessity, the medical necessity information should match up with the run....of course as long as everything is correct on the medical necessity.

 

[BillingSpecialist]

Anyone got any questions this evening?

 

[BillingSpecialist]

A useful piece of information for any of you billing people. It's not good news, but still news worth knowing.

CMS has made the Ambulance Inflation Factor (AIF) official! The AIF for calendar year 2016 is negative 0.4% (-0.4%). Which means, your revenue will be decreasing 0.4%. I know it doesn't sound like a lot, but will indeed add up over time.

 

[Chris07]

In our ePCRs we have the option to state that No insurance was available. This is used especially in the 911 setting where patients often don't have their insurance info on hand. What happens when the patient is billed? Do billing departments enquire about their insurance info later or do they just get sent the full bill? I sometimes get asked what will happen when they don't have their insurance info on them so I would like to know what to tell them.

 

[BillingSpecialist]

At our billing office, we will check eligibility for insurances we are able to check with a social security number. If nothing turns up that way, then we have an insurance form we send out. The insurance form does have the total billed amount on it and from that point on the bill is patient responsibility until they provide us with the insurance information.

So yes, the patient will receive a bill but all they should have to do is call the billing when they get the bill and provide the information.

 

[BillingSpecialist]

In our ePCRs we have the option to state that No insurance was available. This is used especially in the 911 setting where patients often don't have their insurance info on hand. What happens when the patient is billed? Do billing departments enquire about their insurance info later or do they just get sent the full bill? I sometimes get asked what will happen when they don't have their insurance info on them so I would like to know what to tell them.

Not sure what I did that caused 2 posts, but your reply is above

 

[BillingSpecialist]

Anyone got any questions today?!

Hope everyone's having a good week!!

 

[medicdan]

Are crew member (EMT/Medic) signatures required on the PCR? Full names? State certification numbers?