Friday, September 13, 2013

Repeat Patient Pitfalls

“Frequent Flyers”
We label patients in the ambulance industry. Fairly or unfairly, we group patients together and we do so by placing them into “buckets” based on how we interact with them.

One of the most problematic and let’s face it, sometimes disturbing, patient populations are the “Frequent Flyers.”

Drawing the term from the airline industry, these people are the people that we see week in and week out, some of them several times in one week.

Audit Flag
Since this blog addresses all things ambulance billing, the biggest threat that these patients present, from a billing perspective, is that they can potentially become an audit flag on a regulator’s radar screen.
EMS can be placed smack dab in the middle of some auditor’s radar screen because these patients click the reviewer’s negative metrics.
For some reason, there is this assumption in the payer world that EMS is involved in some sinister plot to bilk the system out of dollars when a patient uses pre-hospital services multiple times in a relatively short calendar span.

Aside from the 9-1-1 scenario, repeat routine transport patients really get under the grill of the rule monitors. We’ll concede that the industry “bad boys” who really do have some sinister plot to defraud the system have played an unfortunate role in creating this audit climate we find ourselves entwined in today.

Still we argue that most of us are playing by the rules and doing all we can to serve our communities.

Abusers? At Least Over-Users…
The bottom line is… repeat patients tend to sometimes be abusers or, stated a bit less condemning, over-users of the system.

Naturally “the system” wishes to minimize the costs expended on these patients and therefore often misdirects its efforts to control those costs by pseudo-penalizing the provider community rather than to nip the problem in the bud by manipulating patient habits.

The provider community is easier to directly control. God forbid we upset the patients who are members of political action groups and, ultimately, are voters!

So we’ll focus on fixing the output rather than the input. Audit. Penalize. And, repeat as necessary.

The Billing Office
We close the discussion in this way. There’s only so much your billing office can do to attack this issue.

The billing office can’t change the response scenarios. But, the billing office can provide vital data about the number of responses and funnel feedback to admin regarding the medical necessity picture of repeat patients.

Constant review of these patients is critical. But do you welcome the feedback? If not, you should.

A billing office that’s empowered to report on trends they find as they are turning your PCR’s into claims is vital to your success. Any billing office that can’t (ie. is technologically challenged) or won’t (ie. is foresight challenged) take the time to report to you- in-house or outsourced- is not helping your cause.

This information will lead you to developing a much-needed plan of attack and hopefully before the audit request arrives in the mail.

Education and a Unified Approach
Once you have the numbers and the info in your hands, then you and your EMS administrative staff must develop a plan to communicate with patients and prepare to take action to limit the potential negative effect.

Communication in the form of pubic and individual patient education is critical.

Collaboration with care managers in other disciplines as well as patient counselors at the payer and facility level can be very helpful. Work together with other healthcare providers that also care for your repeat patients so there are unified discussions in joint meetings about the needs of the patient for the long term. Plan to meet those needs with a unified approach that may minimize the number of times you have to visit the patient for less-then-medically-necessary reasons.

Don’t Ignore
Burying your head in the sand is the worst thing you can do for the overall health of your EMS organization when it comes to these patients.

Don’t ignore the repeat patient conundrum.

Pull a report today and look at the number of “frequent flyers” you are serving.

Can you pull such a report? If not, you have a problem. We can tell you Enhanced clients can pull that report.

Does your billing office tip you off about patients who are costing you time and energy? If not, you have a problem. We can tell you Enhanced clients are provided vital feedback on the trends and issues of the day (the reason for this blog, for example).

To learn more about how Enhanced can help your EMS organization identify your repeat transports and a whole lot more; call us today.

Current clients can talk to Client Services about your needs.

Organizations wishing to become current clients can contact Chuck Humphrey at (800) 369-7544, Extension 108 or via e-mail to chumphrey@enhancedms.com.
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