Take Compliance Seriously- Or…It Will Cost You!

Take-Compliance-Seriously-Blog-07-13-2018

In the News

Recently, some scary EMS articles have been published. Here are some headlines…

Fla. Ambulance company to pay 1.2M in federal whistle-blower lawsuit

<Company name redacted> settles Medicare fraud suite for 12.7M

Ambulance company owner sentenced to prison for fraud

Feds crack down on Medicare ambulance fraud

Get the Picture?

Do you get it?

Everyone connected with Emergency Medical Services in America needs to sit up and take notice. If you are swimming in the murky waters of ignoring compliance issues, then you are about to be gobbled up by the hidden shark in those waters.

And…the bite you are about to receive is going to hurt, badly.

None of us who live in this world of all things EMS, especially in the ambulance billing world can ignore how important maintaining strict compliance guidelines is for us. For a long time, there have been those in our industry who thought they were getting away with bilking the entitlement programs out of millions of dollars by “juicing up” documentation, resulting in claims submitted to Medicare, Medicaid and even commercial insurance plans that were anything but compliant.

It’s the end of the road for them.

Wake-Up Call

One of the biggest wake-up calls was the inception of the Medicare Prior Authorization for Repetitive, Scheduled Transportation Demonstration Program.

On Day One of the inception of this trial program, the areas covered by the demonstration- those geographic areas showing the highest over-utilization statistics- saw a drastic decrease in the reimbursement dollars flowing from Medicare.

Of course, we all saw whole ambulance companies padlock their doors and certainly there was quite a debate regarding the program and the impact on access for patients in some rural areas given the loss of services. Yet, now that the dust has settled in the demonstration program States, it seems like life has found a new normal and the chance for those ambulance operators who were operating under-the-radar committing widespread abuse of the system has diminished greatly.

Much to the delight of the Feds, the program worked as intended spotlighting activity that was detrimental to the Medicare system as a whole.

What to do?

So, you’re an ambulance company’s administrator and you read all of the articles and suddenly you have this strange feeling in the pit of your stomach…what do do?

Are we safe? Is my company following all of the rules? How can I be sure?

Relax…there are ways to ensure that you’re coloring between the lines.

Get Help!

First off, there are experts out there that can help you.

Get help!

No one of us can be experts in everything we do. There are those who specialize in all things compliance. Find them…engage them…work with them. Find a partner to help you review and audit all things billing and compliance related. Seek out those individuals and/or companies who can help you be compliant.

The days of going it alone in this business are far gone. You cannot take chances, especially if your run volume is of any size. One repeated mistake in billing can be multiplied over hundreds of claims. If undiscovered, by the time you identify that you have a problem many dollars may have flowed to you from Medicare, Medicaid and/or insurances that you are now liable to re-pay in order to keep you out of trouble.

Compliance is not a one-time thing. It must be a living, breathing, on-going dynamic part of your everyday EMS life just like everything else you do daily be it in the field or in the office.

Consider Outsourcing

Okay, so maybe Mabel has been your “billing person” since 1980-something and you love her to death.

We understand.

But, have you been able to keep Mabel up-to-date on the latest and greatest in EMS billing and compliance? Quite frankly, do you even have a written compliance program backed up by continual audits and monitoring? Or is your compliance program simply a binder with a foot of dust on it, somewhere to the far corner of your office shelf?

Is Mabel a certified coder? Has she been keeping up on the new rules and regulations or have you just not had the time and money to help her achieve your compliance goals?

An outsourcing company, like our company here at Quick Med Claims, can help!

You can be assured that our company has, not only the certified people, but also the processes and procedures in place to closely monitor your compliance- submitting each and every claim in compliant fashion.

Is it time to consider outsourcing?

If your answer is “Yes” then avoid becoming the next headline and contact our office today.

Then tonight…rest easy. We got this!

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