Friday, September 9, 2011

Storm Related Transport Billing

Disaster Transports
This week's torrential rains and record flooding here in Northeastern and Central Pennsylvania combined with last week's encounter with Hurricane Irene caused many of our clients to be pressed into completing spur-of-the-moment, evacuation-type ambulance transports. Although these transports are extremely critical to protect patient safety at the height of the disaster emergency, we find they often do not fit the criteria necessary for billing to Medicare, Medicaid and even some Commercial Insurances after the critical point of the disaster is over.

Many times these transports are inter-facility in nature. They often include evacuations of skilled nursing facilities, assisted living facilities and even transports from private residences to emergency shelter locations. They happen fast and because of the dire need to get these people moved to safety, little thought is given to important things like medical necessity, PCS forms or origin and destination requirements.

But after the dust settles...
After the emergency is over and things return to normal, then we suddenly realize that it would be helpful to be paid for the resources expended to handle the emergency. Many times these events include paying staff overtime, a lot of fuel and lost revenue from regular daily business that could not be conducted in deference to the disaster transports.

That's when our phone rings here at Enhanced asking for direction on how to get these claims paid.

Possible Payer Sources
Consider right up front that the payer sources may not turn out to be the ones you normally receive checks from. Although Medicare and Medicaid have allowed some exceptions in the past (most memorable was special billing privileges and requirement relaxations following the Hurricane Katrina disaster several years ago), these exceptions are rare. Bending or dropping the rules, literally requires Acts of Congress in order for the Medical Administrative Contractors and State's Medical Assistance program administrators to routinely drop stringent requirements related to the payment of transportation claims. Needless to say, such special acts do not happen quickly and easily and most of the time never even come up for discussion.

So, without meeting medical necessity requirements or if the disaster-related trip originates and concludes in combinations not approved for payment under the written billing guidelines, responsibility for payment reverts to the sending facility, State or Municipal Government source or, even worse, falls back on the patient.

This is when collecting becomes a challenge for the billing company.

The Most Important Steps
So what's the answer? Well, each disaster is unique. There are no concrete rules to follow and often the "rules" are created as the aftermath unfolds.

We recommend the following steps.

First, document, document, document! Document these trips extensively in an even more detailed fashion than you normally document. Be sure to have your field crews document everything about the patient, especially noting why (or why not) you feel that the patient could not have been transported safely by any other means. You should be requiring this normally, anyway- disaster or not- but it's even more important than ever that you do so now.

Second, be sure to record who requested the trip complete with contact information on how to reach that person or agency after the disaster is over. "They called me..." or "Emergency Management told me they'd pay us" gives your billing contractor nothing to work with because there's no name or direct requester to refer back to. If payment is "guaranteed" be sure you at least know who guaranteed it, what their title or role is with regards to making that request (are they authorized) and if possible get them to issue a written statement (even if it's an e-mail) regarding their ability to commit to payment for your services after the fact.

Finally, record insurance information and also collect next of kin information. If it turns out later that the facility or EMA agency fails to follow-through with their promise to pay, having a contact person to help you (and your billing agent) petition for payment via an appeals process, etc. will be extremely helpful as we fight to get you paid.

Sometimes even with the best of efforts claims for services provided during a disaster can go unpaid. Enter into the disaster knowing that a qualified billing contractor should do everything to help you state your case, but be realistic that even the best of EMS billing contractors may be limited with regards to their ability to press the case if the rules just don't allow for payment.

In the end, thanks for all that you do- in good times and in not-so-good times.

Remember, disaster emergencies present obstacles and challenges that go far beyond what one can imagine, unless you've been involved in provided EMS services during such events. You obviously met that challenge in the field. Expecting payment in return for your efforts is both reasonable and necessary to cover the costs of providing those emergency services. Use the steps above to give your department and especially your billing agent a fighting chance to collect those necessary dollars!
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