Friday, January 3, 2014

3 Things to Consider for your EMS Billing Program in 2014

Happy New Year!
Well here we are, it’s January 2014. Happy New Year!

We trust you had a wonderful holiday season. Now reality is back and already first responders across the United States have met the winter monster called “Hercules.” No rest for the weary, as the old saying goes.

Where’s you’re billing program going?
Here’s the question of the day. Now that the revelry is past and the operations issues of dealing with a major winter storm are in full swing, have you had time to even think about where you’re EMS billing program is going in 2014?

Probably not.

So allow us to help you wrap your brain around where things should be heading for you inside your billing office- which may be down the hall or in the next State.

3 Areas to Consider
Were recommend that you focus on three areas right now as you set your goals for the New Year.

Consideration 1 – Documentation (ICD-10)
There’s no time like the present to brush up on your documentation focus. You’re reading this space because you’re either a First Responder, an EMS Administrator or most likely you fill both roles.

There’s not one of us that can’t learn something new about how we document our EMS runs on the Patient Care Reports that we prepare. Plus you know that we’ve warned about the coming ICD-10 coding change that will hit the industry in October.

Without major changes in the detail we all put into the PCR’s we write, it’s going to be difficult for your billing office to apply the new codes to your scenarios in order to get claims paid. So before it hits us all in the wallet, now’s the time to make your mind up about becoming a better documenter.

We’ve provided you with a whole set of blog articles that are nicely archived for your reading pleasure. Read them, please!

Or take a class, either an EMS class (highly advised) about documenting or maybe even consider taking a short writing class at a local Community College or University (maybe even something that can be accomplished online.) Heck….you’re going to better yourself and contribute greatly to your organization all at the same time.

That’s a win-win!

Focus 2 – Community Paramedicine
By now we’re sure you’ve heard of the buzz phrase, Community Paramedicine.

Do you know what it is? Is anyone talking about it within your organization?

We suggest that you read up on what’s going on across the nation. Ask yourself, how does this apply to me? How does this apply to my EMS organization?

Eventually, the paradigm we operate under for today’s EMS in America is going to shift. How long it takes to get to your pocket of the universe remains to be seen.

As we discussed a few weeks ago, there are still a lot of unanswered questions surrounding Community Paramedicine, the biggest of which is; Who’s gonna pay for it?

However, to bury our collective heads in the sand while thinking this will all pass….well don’t you think there were those back in the 1960’s and 70’s that thought the same thing about Advanced Life Support and the push for paramedic skills?

Bottom line is….Community Paramedicine like the ALS push of yesteryear is not going away. What it evolves to become remains to be seen.

But, now is the time to think out of the box. YOU can help create this thing. You can be part of the discussion giving positive input now or be caught grumbling later when the whole thing passes you by.

Start asking questions. Get together and talk about what your EMS organization can do to expand services in your community. Even if it’s just on a white board in your conference room, it’s time to start talking about what it can be for you- big or small organizations alike.

Set up some brainstorming sessions with local hospitals and healthcare organizations. How can every part of the healthcare community benefit through cooperation? Talk with the decision-makers, Congressmen and Senators at both the State and Federal level. What local officials can help you further the cause? They need to hear from you just like you need their help in driving things to benefit your organization and its unique place within the landscape.

Focus 3 – Obamacare- It’s Affects and Compliance Spillover
For the past several months, thanks to the glitches that have plagued the rollout of “Obamacare” all we have heard about is that thing called the Affordable Care Act (ACA).

Now that it’s here and it looks like it’s going to stay, we all must be ready for how it’s going to affect those of us in pre-hospital.

One of the major issues is the ratcheting-up of compliance monitoring which has been somewhat ushered in secondary to all the hoopla of the implementation of the program, nationwide.

The money to pay for this new initiative comes in large part from the tightening of the belt in other areas. Notably, by pulling back what the Feds believe to be money that is flowing needlessly to other programs, the recovered dollars from fraud and abuse initiatives can be funneled into paying for the new coverage stipends that drive the new healthcare system.

Every ambulance service should expect an audit from some health insurance payer at some point. If it never happens for your organization….that’s great! But, it’s more likely than ever that you may see a request for a review of the claims submitted by your organization for payment at some point down the line.

Are you ready?

Do you have reason to panic if one of those letters arrive in your billing office today? Only you can answer that question. But if the answer is a resounding “Yes”, then now is the time to make sure you are ready.

Is anyone in your organization preaching compliance? Is anyone doing internal, external, pre-claim and/or post-claim audits of claims? Does your organization have a compliance plan that you follow? Does your billing office employ sound compliance practices in the day-to-day operation on your behalf?

Also of consideration regarding the ACA is how the ACA will potentially affect your operations and by extension your cash flow and costs.

Will a large percentage of your patient population that has been uninsured, suddenly become insured?

Sound good?

Well it might be, but what if that coverage has high deductibles or is subject to the pitiful Medicaid fee schedule that exists in your State? Will you be turning wheels for the few dollars that will be coming in to cover your costs (or that don’t really cover your costs?)

Are you going to need to beef up staffing to cover increased call volume?

Probably.

One government report just released in the last few days shows a significant increase in the use of emergency services for people covered by a Medicaid program under the new initiative versus when they lacked coverage- and much of it is not justified. But services are being used by patients, anyway, just because those services are now “covered.”

Have you sat down and tried to come up with a budget model that covers all of these potential changes?

We asked the questions…
So there you are.

We asked the questions for you. Are there others? Sure.

How long is it going to take you to ask them? Will you ask in time to form a plan or find yourself playing catch-up come April, May, September, October?

Overwhelmed? Wait! There’s help out there if you need it.

For example, at Enhanced we offer as much education and information as we possibly can to the clients we serve. Do you have that kind of support at your fingertips?

If you can’t answer the last questions in the affirmative, then maybe it’s time to think about gaining access to that kind of data and information supply that can make your thought process easier.

We can help you find the answers to the questions you will hopefully begin to ask.

We’re here to help. Let us know if the experts, here at Enhanced, can help you find the answers to the questions that need to be asked for your EMS organization in 2014.

Call Chuck Humphrey today at (800) 369-7544 or via e-mail to chumphrey@enhancedms.com.

Happy New Year! 2014 is going to be a thrill for sure!
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