Introducing the “Z” Codes Fast Approaching! ICD-10 is fast approaching! Come October 1st the healthcare industry begins to use the new diagnosis coding regimen and with that transition the ambulance billing industry will face a new set of rules and billing guidelines to follow including the “Z” codes. Reasons for Encounters… The “Z” codes denote […]
Documenting Emergent Scenarios Post October 1 Focus If you’re a regular reader of this space you are aware that we focus A LOT on medical necessity, especially as the definitions contained in the rules pertain to Medicare. With anywhere from 40% to 60% or upward of the average ambulance reimbursements being derived from Medicare Fee-for-Service […]
CMS Releases Further Clarification and Guidance about Prior Authorizations Here to Stay The Centers for Medicare and Medicaid Services (CMS) Prior Authorization Demonstration Project is here to stay. Put in place by CMS as a pilot project in the States of New Jersey, Pennsylvania and South Carolina in December, 2014; the program requires that all […]
The Importance of Building and Maintaining Relationships Beyond EMS More and More… More and more we in EMS are being called upon to interact and develop relationships that go beyond our brothers and sisters in the Fire/EMS arena. It doesn’t matter what level of the organizational chart you serve, we all have a duty to […]
Grading the Documentation Pop Quiz-Scenario 1 How did you do? Last week in this space we began a 3-part series that we entitled “Our Documentation Quiz.” If you missed it, we suggest that you skip down and read the post or you’ll be lost by reading this week’s post. We presented two hypothetical EMS scenarios […]
3 Reasons the Billing Office Can’t Bill Your EMS Incident We polled the staff… This week we polled our staff here in the Enhanced Management Services billing office to learn what their biggest hurdles are when processing incoming Patient Care Reports (PCRs) for billing. Our staff are on the front lines every day, reading PCR […]
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 […]
“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 […]
Non-Emergency Transports- Two Questions to ALWAYS Ask Big Brother’s Watching! Never before has the ambulance industry been so much under the microscope when it comes to billing and receiving payment for ambulance transports- especially non-emergency transports. Federal Government, State Governments, you name it. “Big Brother” is watching what we do. The focus has increased dramatically […]
Let’s Take a Walk! Walking, Medical Necessity and Billing Join us today as we take a few minutes to explore medical necessity issues surrounding patients who can ambulate and how that fact alone may affect billing for an ambulance transport. Medical Necessity Any claim for payment billed for ambulance transport must meet a medical necessity […]
