PCR/Billing question regarding consumables

[ineedmoneynow]

is everyone required to list consumables separately from procedures in your pcr? I currently work for a small als transporting fire department (2 med units) and our office techs are under the impression that our billing company (whitman) requires us to list consumables separately from just the procedures in imagetrend. we have a considerably high turnover rate for various reasons and it is very difficult to get employees to select the correct conumables which results in our office techs spending many many hours reviewing them and kicking them back prior to sending them to our billing company slowing down the process considerably. i have worked for multiple other agencies (some used the same billing company) where this was not an issue as employees were not required to select billing/consumable options only procedures performed. From what i gather, it would appear the billing company should be the ones reviewing the pcrs and determining what to bill for. thoughts? comments? concerns? thanks

 

[NomadicMedic]

We do not bill for consumables, and only use the tracking in ESO to help account for usage. I have never been at an agency that line item bill’s consumables.

 

[akflightmedic]

I cannot imagine ever trying to line-item bill for consumables and frankly have never seen this practice in EMS. Can I ask why such a small service ever put this into practice? Your ambulance transport fee should be constructed in such a way that it covers any and all consumables used.

Even hospitals have gotten away from line-item billing.

 

[MMiz]

No. I don’t know of any agency that does it the way described.

If it is how it’s done at your agency, it’s time to change the process.

 

[Aprz]

I've seen this done. Some places have you list every single thing you use eg 18G, flush, alcohol wipe, lock/extension, tegaderm, and tape. Some of them have them lumped together eg IV start kit. When they are lumped together, it is a lot easier to do. I assume that people are more likely to do it and more likely to do it correctly if it is lumped together. I have little idea about how billing works.

 

[NomadicMedic]

If you are billing Medicare, CMS doesn’t allow you to line item bill.All the supplies, drugs and staff charges are included in the level (ALS1, ALS2 or SCT) I know some agencies that are contracted for IFT or hospital based can wrap all that cost up into patient movement, but it feels like a lot of work for minimal return. You can also line item bill if it’s a private insurance plan or self pay, but it’ll probably just get negotiated down.

 

[PotatoMedic]

When I did billing we did not do line item. Way to time consuming for little to no return. As it was said CMS won't allow it and most insurance companies I'm told fuss about it. Standard rates are simpler, less tricky to bill, easier to get approved by insurance, and usually more successful to be paid. Maybe you can get an extra 50 dollars by itemizing... But it might cost you an extra hour or two in claim processing which probably isn't worth it at that point.

 

[Tigger]

We are required to put the consumables in so they can decide what rate to put on it. Could they just look in the flowchart/treatments? Yes. But when your EMS leadership has never run an ambulance service, it’s easier to just tell the crews to do the consumables.

 

[E tank]

Hospitals figured out they could reach the maximum allowable billing a lot easier for a standard 'room fee' with presumed services/disposables. so they did.

 

[akflightmedic]

We are required to put the consumables in so they can decide what rate to put on it. Could they just look in the flowchart/treatments? Yes. But when your EMS leadership has never run an ambulance service, it’s easier to just tell the crews to do the consumables.

Is it that hard to determine ALS or BLS run? Seems the crew ticking a box would be way faster than a biller trying to deduce it from the list of consumables used.

 

[Tigger]

Is it that hard to determine ALS or BLS run? Seems the crew ticking a box would be way faster than a biller trying to deduce it from the list of consumables used.

They took that box away from us for reasons not understood, I assume for inaccuracy though there was no distributed guidance. Our billing company wants us to code them before we send them so our EMS staff does that, makes little sense to me.

 

[akflightmedic]

Excellent inefficient use of a service you pay for...billing company takes 3-5% typically, and you guys are lightening their load. All they need to do is hit send and collect...simplified I know, but legit the gist of that set up.

 

[Tigger]

Excellent inefficient use of a service you pay for...billing company takes 3-5% typically, and you guys are lightening their load. All they need to do is hit send and collect...simplified I know, but legit the gist of that set up.

Indeed. Though for whatever reason every place I’ve worked in this state has done pre-billing. My last place which was much more dialed did it as there are a lot of EMT skills in Colorado that could be billed as ALS So long as a paramedic provided an assessment (IVs and med admin to start).

 

[Medicsince1999]

Indeed. Though for whatever reason every place I’ve worked in this state has done pre-billing. My last place which was much more dialed did it as there are a lot of EMT skills in Colorado that could be billed as ALS So long as a paramedic provided an assessment (IVs and med admin to start).

is everyone required to list consumables separately from procedures in your pcr? I currently work for a small als transporting fire department (2 med units) and our office techs are under the impression that our billing company (whitman) requires us to list consumables separately from just the procedures in imagetrend. we have a considerably high turnover rate for various reasons and it is very difficult to get employees to select the correct conumables which results in our office techs spending many many hours reviewing them and kicking them back prior to sending them to our billing company slowing down the process considerably. i have worked for multiple other agencies (some used the same billing company) where this was not an issue as employees were not required to select billing/consumable options only procedures performed. From what i gather, it would appear the billing company should be the ones reviewing the pcrs and determining what to bill for. thoughts? comments? concerns? thanks

I did billing for years, each payer has its own rules . Codes like A0428, A0427, A0999 A0435 A0998. Medicare has bundling ie base, miles, supplies are included. The state public aid policies may allow for oxygen reimbursement. Medicare and medicaid sometimes follow different guidelines if contracted. Work comp, auto, Federal plans and VA plans may use repricer to set reimbursement. Private insurance depends on contracts. Also remember 3% is recouped on all 1500 billing (ambulance form to receive payment ) by Medicare due to sequestration- to balance the budget. Medicars/ wheelchair trips not seen as a covered medical benefit. Helicopter/ rotorary is another animal. CCT/SCT is always non emergency . The code for fix wing transport is the same. Medical necessity doesn't equal emergency. There is so much finesse to paper or electronic billing for ambulances. Even the code to describe what we do on the ambulance is crazy hard to understand. Any questions just ask. Can send links if further information is needed

 

[Akulahawk]

Hospitals figured out they could reach the maximum allowable billing a lot easier for a standard 'room fee' with presumed services/disposables. so they did.

Critical access hospitals can, and do, billing for the consumables. Those hospitals are small enough that they cannot survive on DRG billing. From what I understand, most hospitals get an overall better reimbursement through DRG billing which would include a daily room fee with all the nursing activities, consumables, and the like all built-in.

Personally I think that while billers understand and know what ambulance companies can bill for, that information is not always passed on to leadership or the crews, so leadership figures that if the crews itemize what supplies were used and that's passed on to the billers, maybe the billers can find some way to get more reimbursement for the supplies... Probably the same goes for procedures performed. Reimbursement for that probably includes assumed consumables to complete the procedure, assuming the procedure is a separately billable item.

Tracking supply usage is a needed thing... so you now when you need to reorder the supplies. I don't necessarily care HOW that usage is tracked, per call or during restock of an ambulance, but it should be done so you don't run out of necessary supplies.

 

[Medicsince1999]

Critical access hospitals can, and do, billing for the consumables. Those hospitals are small enough that they cannot survive on DRG billing. From what I understand, most hospitals get an overall better reimbursement through DRG billing which would include a daily room fee with all the nursing activities, consumables, and the like all built-in.

Personally I think that while billers understand and know what ambulance companies can bill for, that information is not always passed on to leadership or the crews, so leadership figures that if the crews itemize what supplies were used and that's passed on to the billers, maybe the billers can find some way to get more reimbursement for the supplies... Probably the same goes for procedures performed. Reimbursement for that probably includes assumed consumables to complete the procedure, assuming the procedure is a separately billable item.

Tracking supply usage is a needed thing... so you now when you need to reorder the supplies. I don't necessarily care HOW that usage is tracked, per call or during restock of an ambulance, but it should be done so you don't run out of necessary supplies.

Hospital bill on a UB form to insurance, ambulance bills on a 1500 form. Drgs are for hospitals to standardize length of stay. HCPCS are what is used to describe what is done and reasons for ambulance. Tachycardia for adults is looked at as an emergency code. A pediatric patient tachycardia is normal. Replacing supplies are different at each hospital in every region. Private ambulance vs fire ambulance vs a state EMS system.

 

[Phillyrube]

The two EMS regions I worked, we restocked at the hospital. We drew supplies and scanned barcodes which then were billed to the patient.

 

[ineedmoneynow]

thank you very much for the replies. very insightful! i am working on changing how we do this and sometimes its difficult to break through to people when theyve been set in their ways for so long.

 

[FiremanMike]

They took that box away from us for reasons not understood, I assume for inaccuracy though there was no distributed guidance. Our billing company wants us to code them before we send them so our EMS staff does that, makes little sense to me.

Our billing company figures it out for us, they calculate mileage too.. it's quite convenient.

I've been with this same billing company with two different departments and have always found them to be fantastic and easy to work with

 

[ineedmoneynow]

Edited