Financial Pressure with Positive Transition

Medical Transport Provider

The hospital based medical transport program in this case was experiencing substantial financial duress and had a number of compliance risks prior to the transition. Program leadership was under pressure from the sponsoring hospital leadership to achieve a neutral financial position. Program leadership engaged an outside consultant to review the performance. The findings included compliance concerns, as well as, poor reimbursement performance.

Situation

The hospital based medical transport program operates both air and ground medical transport services within a defined geographic area, serving the sponsoring hospital and other institutions in the region. The program transitioned its billing and reimbursement process to Quick Med Claims (QMC) in the fall of 2009. The billing and reimbursement process for the operation was historically handled by the Central Billing Office (CBO) group at the sponsoring hospital. The reimbursement performance was below the industry benchmarks.

Background

The program completes more than 30,000 ground transports and 1,000 air transports annually. The transports include a typical mix of scene responses and interfacility transports.

Assessment

During the implementation process, the QMC team identified several opportunities for improvement within the billing and reimbursement process:

• The CBO was experiencing declining reimbursement performance over a multi-year period prior to the transition.
• It appeared that the CBO did not have medical transport specific protocols in place, including defined processes and established benchmarks for billing.
• The accounts receivable management process was poorly organized and provided incentives for staff to focus only on the “low hanging fruit.” The CBO quickly moved claims of to a precollection process that was both more costly and less Patient friendly.
• Some of the processes used by the CBO were not fully compliant with all of the applicable regulations. Prior consultants had identified several risk areas that needed to be addressed.
• The CBO was experiencing significant staff turnover and the transport program had multiple primary contacts within a short period of time.
• There was little to no feedback for program leadership relative to the billing and reimbursement process (and its impact on operations).

Recommendations

The QMC team worked with the client team to make a series of changes in the billing and reimbursement process:

• QMC assumed primary responsibility for the AMS billing and reimbursement process in early 2009.
• The QMC team completed the billing and reimbursement process in turnkey fashion; however the team used billing software that was deployed on the Client’s network.
• The QMC team worked direct with the Client hospital compliance leadership to develop a compliance program specific to the medical transport operations.