Friday, October 17, 2014

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 after PCR, processing claim after claim and sending bill upon bill.

3 Reasons the Billing Office Can’t Bill Your EMS IncidentSo what better group of people to query about the state of PCR’s as they are received for billing?

Our poll produced these top three hurdles.
1. Incomplete Documentation
This is the number one reason identified by all of our staff and keeps them from processing a trip for billing, initially.

Missing patient demographics is part of the problem.

Correctly identifying patients is an absolute must. There is no magic wand database that we can tap into to identify people. The billing office staff aren’t normally part of the patient care loop, so if the PCR does not properly identify the patient by name and include the basic demographics, then billing is going to be delayed.

Patient demographics can be obtained in a number of ways. Information can be pulled from a hospital face sheet and/or by copying, or at least viewing, insurance cards. Simply questioning the patient or patient representatives gleans a lot of information but we certainly understand if people are less than cooperative.

Trust me. We’ve been there!

The simple things we billers must convey to all of you in the field, is that incomplete documentation holds up way too many claims and, frankly, that frustrates us here in the billing office at times.

Beyond demographics are the times when the written narrative fails to paint a picture in words about the incident. If there is inadequate medical necessity documentation which fails to describe the reasonableness for the trip, the run cannot be billed. The billing office can’t fill in the blanks.

No detail should be omitted when completing a PCR. Clear clinical documentation that is concise and complete must be written into every free-hand narrative that providers prepare. The billing office cannot assume or “read between the lines” to determine the medical necessity of the patient. The words have to be there in black and white and those words must include clinical findings with assessed values applied.
2. Non-Emergency PCR’s that miss the mark
Too many of us attempt to document non-emergency transports like they are emergencies. It just doesn’t work.

In our opinion, providers have a more difficult burden of proof when prepping PCRs to explain the medical necessity for patients who are receiving non-emergency or routine ambulance services. Plus the trip must be proven to be reasonable in nature.

We suspect that too many providers look to the Physicians Certification Statement (PCS or “the medical necessity form”) as a type of prescription that somehow takes them off the hook from writing a detailed PCR for the incident.

The PCS is not a “get out of jail free card.”

In fact, the documentation in the PCR trumps the PCS in all cases. Non-emergency documentation must be truthful and factual. Full assessments are required (the patient is in your care), relative values must be assessed and the PCR must present a full justification for why the patient in question was not able to be transported safely in any other vehicle other than an ambulance.

The PCR presents the case to the insurance payer and supports that payment should be made to your EMS agency for the ambulance transport. While many of these patients have long-term or chronic issues, the subject of the PCR must always focus on the present condition and medical necessity of the patient at the time of transport.

The documentation must include the patient’s condition before, during and following transport. Narratives should include how the patient was found, how the patient was transferred and extricated from the origin location and finally the disposition of the patient at the destination point.
3. Incomplete PCS Documents
Touching again on the non-emergency side of the business, even though we don’t prepare the PCS at the ambulance level, we are responsible for insuring that the PCS is complete and can be used to support the claim.

The big tickets items that fail PCSs, thus torpedo billing revolves around two main areas…
  • Improper signatures -and-
  • Missing Information
A PCS that is signed by the wrong person or a PCS that is not signed correctly is useless. Someone must insure before the trip is sent to the billing office that the PCS has been signed by an appropriate and acceptable healthcare provider. We all know by now that doctors must sign a PCS for repetitive transports. Non-repetitive transports requiring a PCS must also be signed by appropriate persons with direct knowledge of the patient’s overall status.

Signatures must be legible and if they are not legible then the healthcare provider/signer’s name and credentials must be printed/typed on or near the signature. In addition, there must be a date that connects to the signature directly, denoting when the healthcare provider that signed the PCS actually signed the PCS.

We suggest that EMS agency administrators responsible for supervising field operations review and dialogue with the billing side of the operation so everyone is in sync with what to look for when the PCS is collected.

The Ambulance Billing Services blog is provided as an educational tool by Enhanced Management Services, Inc. Enhanced is an all-EMS third-party billing contractor with EMS agency clients located across the U.S.A. For more information about Enhanced, visit our website at www.enhancedms.com and click on the “Get Started” button.
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