Immediate Financial Improvement

Air Medical Service (AMS)

The air medical services (AMS) program in this case was operating on solid financial footing; however program leadership was concerned that the billing and reimbursement performance was below area benchmarks.

Situation

The AMS program transitioned its billing and reimbursement process to Quick Med Claims (QMC) in the fall of 2013. The billing and reimbursement process for the AMS operation was historically handled by the Patient Business Services (PBS) group at the sponsoring hospital. The reimbursement performance was below the industry benchmarks.

Background

The AMS program completes more than 500 patient transports per year, including a mix of scene responses and interfacility transports. Program leadership and hospital leadership sought additional feedback/benchmarking through their aviation management partner. An independent consultant was engaged to evaluate the billing and reimbursement performance. That consultation resulted in confirmation of their suspicions. Hospital leadership elected to outsource the billing and reimbursement process.

Assessment

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

• The reimbursement per transport was below $4,010. This performance is well below the national and regional benchmarks.
• There were a number of hospital driven processes that resulted in a negative impact on the billing and reimbursement performance, including use of the hospital billing software (not geared toward transport).
• The clinical documentation quality was solid, but some opportunities for improvement were identified.
• Some of the processes in place were less than efficient and needed to be adjusted to allow for maximizing the reimbursement per transport.
• The sponsoring hospital resources committed to the AMS program billing and reimbursement were well beyond the benchmarks, indicating less than optimal efficiency in the process.
• The charge structure was not consistent with industry best practices and the levels were well below the range of charges in the region.

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. The majority of the processes were changed to the QMC operating standard.
• The QMC team continues to work with the leadership at the sponsoring hospital to adjust the processes in order to ensure compliance, maximize reimbursement and deliver quality customer service to patients and families.
• The QMC team provides regular feedback to AMS program leadership regarding the quality of the documentation and has offered educational programming to enhance the performance.
• The payor contracts were analyzed and QMC made recommendations for action to mitigate the low reimbursement levels in each case.
• There was an initial charge structure adjustment at the time of the transition and the sponsoring hospital leadership plans to complete an additional adjustment in 2014 in order to make the structure and levels consistent with the prevailing practices.