The “Continuous Monitoring” Factor for Inter-facility, Non-emergency Ambulance Transports From the Open Door Forum One of the staples of being an ambulance biller is religiously following any information provided by the Center for Medicare and Medicaid Services (CMS). Ambulance billers can easily follow CMS by participating in the Ambulance Open Door Forum audio-conferences. The Open […]
Movement Barriers and Medical Necessity Outside-the-Norm Questions Our office receives questions from our EMS agency clients, periodically, regarding patients that have some kind of movement barrier connected to the treatment/transport scenario. These are the patients that have some sort of physical or structural challenge that exists between where they reside and the point where they […]
Is Your EMS Agency Experiencing Payer Mix Shuffle? It’s happening now… There’s no doubt healthcare in America is being changed daily. The Affordable Care Act (of you may refer to it as “Obamacare”) is changing the face of the healthcare and the health insurance landscape in America. How is all of this affecting your EMS […]
Understanding the Medicare Prior Authorization Demo Project Repetitive Scheduled Non –Emergent Ambulance Transports The Centers for Medicare and Medicaid Services (CMS) just announced that they will pilot a demonstration project to pre-authorize Repetitive Scheduled Non-Emergent Transports. Repetitive Scheduled Non-Emergent Transports are defined when the same patient is transported three or more times over a ten-day […]
More Medicare Claim Processing Insight- Transporting ESRD Patients for Dialysis Second Week in a Row… Last week we filled this space with information from the Medicare Administrative Contractor (MAC) handling Part B claims in Ohio and Kentucky regarding their Comprehensive Error Rate Testing (CERT) findings. We provided you with a view of how the CERT […]
“Ambulance Service: Incomplete Documentation”- The CERT Perspective It Doesn’t Happen Often… Not often do we ever get a chance to gain a first-hand look into how decisions are made by Medicare compliance auditors. This week we had the chance to do so. CGS- J15 MAC CERT Our e-mail inbox chimed a few days ago, pretty […]
The ABC’s of an Ambulance Billing Company DNA There are many ambulance billing companies out there. These companies come in all sizes and shapes. Some are good; really good. Some are bad; really bad. A really good ambulance billing company has a basic DNA that involves these ABC’s. The same basics may apply to the […]
Between the Lines Never a Time We’re going to begin this post with a blunt statement. There is never a time when your ambulance billing office can read between the lines! We talk A LOT about the documentation of ambulance transports in this space. Today we’re going to get about as fundament as we can […]
Insurance Coverage Doesn’t Mean Insurance Payment In the news… The local newspaper that serves the area surrounding the offices featured a story about a large hospital system in this area that is realizing significantly lower insurance payments as the effects of the Affordable Healthcare Act (a.k.a. “Obamacare”) kick in. “Just because there are more insured, […]
The Significance of One Hundred Late last week, we published our 100th blog post. It’s not something we were anxiously counting down to, nor waiting to celebrate—that’s just not our style. In fact, the “centennial” wasn’t even on our radar, and (quite honestly) we discovered it by happenstance. In realization of this milestone however, we did take some time to […]
