Compliance Isn’t Easy

Being Deliberate

If your EMS agency is going to strive to be 100% compliant with all of the rules and regulations that we all have to navigate in the EMS billing arena, then it means that your organizational culture must be deliberate.

Compliance isn’t easy.

Compliance Isn’t Easy

The problem with what we have just written is the busy EMS world that we all operate in every day, sometimes does not allow for difficult. Time to think and do becomes just do and worry about it later.

That’s where we have gotten into trouble in the past.

Margins are tight…

Because every EMS agency’s operating margins are tight, we tend to get into a mindset that seems to justify cutting a corner here and there because we feel we are entitled to be reimbursed by whatever means.

We can all become very lofty in our heads… “They owe us this money because they underpay us anyway.” This leads us to believe that we have some kind of righteous moral high ground and can look the other way if we are reimbursed by cutting corners and looking the other way when compliance rules are cheated.

Not so!

Rules are Rules

The rules are the rules. In this greatest nation on earth, whether you agree with the politics on Capitol Hill or not, if Congress or a State Legislature superimposes a requirement on us then it is what it is and we must comply.

It may not be easy to record odometer readings to the nearest tenth of a mile, but we all have to do it.

It seems trivial that a healthcare professional cannot just sign a Physicians Certification Statement with the same scribble the doctor uses on his/her prescription pad and must print his/her name, credentials and date the signature too. Plus it really seems unfair that we have to chase after that same doctor when he/she doesn’t follow the rules.

But we have no choice.

The Penalties are Stiff

No longer do we operate in a culture that we can just make up for it on the back end. Failing to comply with the rules today can result not only with the requirement to pay back the money that should never have been paid in the first place, but it may also result in civil and/or criminal penalties depending on the severity of the infraction.

The penalties are really stiff and the elected officials give more power to the bureaucrats every day. Routine audits are commonplace. Recovery activity is at an all-time high.

Navigating the Waters

So to navigate the waters, your EMS agency must work hard and continuously to foster a culture of compliance. We offer these steps to begin and succeed at the process…

  1. Focus on excellent documentation- we preach this continuously in this blog space and we are laser focused on educating our clients within our billing office culture. There must be continual dialogue and education with the people that are crewing your ambulances regarding the effectiveness of their documentation in the Patient Care Report (PCR) which is the direct link between the street and the billing office. Your billing office must be an equal watchdog over the process and by the same respect, someone should be diligently watching over your billing office.
  2. Ask questions- EMS agency administrators must constantly be asking questions about the process in order to determine if any coloring is falling outside of the lines. If you, as an administrator, don’t feel qualified to do a systems review on the billing process- and we mean from street to office to payer, then bring an objective someone in to review the process. Likewise, be certain if you are outsourcing your billing to a third-party that you can constantly monitoring the flow of information. Be sure that your billing contractor has a keen understanding of all of the rules and regulations.
  3. Build compliance training into your routine- the staff on the street and in your billing office won’t just osmose the rules and regulations nor will they know how to apply them without training. Are all of your billers (in-house or outsources) Certified Ambulance Coders? Do you regularly work compliance-focused training into your staff meetings?

Unless the edict to be compliance fanatical comes from the top down, your EMS agency will be open for a slip. That slip could become very costly, embarrassing and maybe even fatal.

Run! Now! Begin today!

Dust off that compliance plan binder on the shelf and make it work!

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