Friday, October 9, 2015

The Bad Apples Ruin the Whole Bunch

1 in 5!
Just one week ago, the Department of Health and Human Services Office of the Inspector General (OIG) released a nationwide report citing questionable Medicare billing practices by ambulance suppliers, nationwide.

The OIG reports that 1 in 5 ambulance providers has engaged in “questionable billing” practices.

In short, the “bad apples” are ruining the whole bunch. They are causing the overseers to paint us all in a bad light until we prove otherwise.

This is a disservice to all of us in EMS!

The List
The OIG cited these practices in the report.
  • Billing for a transport without a Medicare service being provided at the origin
  • Billing for excessing mileage for urban transport
  • Billing for a high number of transports per patient
  • Billing using compromised Medicare ID number
  • Billing for an inappropriate or unlikely transport level of service
  • Billing for a patient that is being shared among multiple ambulance suppliers
  • Billing Medicare for transports to/from partial hospitalization programs

We’ve heard…
What angers those of us who play by the rules, are the EMS agencies who blatantly disregard remaining in compliance with the regulations.

We recently heard third-party of a rather large ambulance player whose administration outright instructed their billing office staff to “pick a diagnosis code that fits to get the trip paid” because “they’ll (CMS,OIG), never know the difference.”

Then we wonder why we are under the OIG’s microscope? It’s inexcusable!

To their credit, reputable members of that EMS agency’s billing staff bolted for the door and we understand that EMS agency is now being audited.

Fraud and abuse never pays!

Upcoding…NOT!
This billing office demands that all of the EMS agencies we serve require their providers and office staff to represent each and every EMS incident truthfully and accurately. This is why we promote that each Patient Care Report submitted for billing contains clear clinical documentation along with a precise, detailed written explanation of the entire scenario as it unfolded in the field, emergency or non-emergency.

The OIG report cited they found attempts to “upcode” trips during their review of a sampling of ambulance claims submitted to Medicare.

For example, suspect EMS agencies were attempted to bill Medicare for emergency transports where the destination was something other than a hospital. Specialty Care Transports (SCTs) were being billed where the final destination of the patient was a dialysis facility or private residences.

Dialysis Cited Again
Of course, once again the report called out dialysis transports which are highly suspect and causing so many problems across the nation. At some point, select ambulance suppliers in certain metropolitan areas learned that they would make a quick buck providing ambulance service to end stage renal disease (ESRD) patients who can literally walk from the ambulance to the treatment location.

No Medicare Service Provided
Plus, the study also focused on ambulance transports billed and paid by Medicare when patients ultimately received no Medicare service at either the origin or destination facility.

Remember, Medicare covers transport to and from service when the patient cannot be transported by any other means. So the supposition is, if they needed no services at Point A or Point B, then why transport in the first place, not to mention why bill Medicare?

Mileage
Our clients know that this billing office is strict about mileage records. The reason we require strict and accurate odometer readings in the Patient Care Report is magnified by this report’s findings.

The report clearly notes that there was a factor of excessive mileage billing, especially in some urban areas where there are many hospitals in close proximity to patient locations. Obviously, this finding indicates that unscrupulous ambulance suppliers were billing for additional miles that were not traveled when transporting patients or the report cited their suspicion that ambulance suppliers actually transported patients to more distant facilities than the nearest appropriate facilities in order to collect additional mileage payments.

While this is an unthinkable practice for most of us, we can see how this can potentially be a fairly easy means for an EMS supplier to make more money but in an inappropriate manner.

What’s it mean?
All of this means that we must follow the rules. Everyone in EMS suffers when some of us don’t play by the rules.

Plus, thanks to these idiots we now can expect even more scrutiny by the watchdogs. But then again, if you’re playing by the rules you have nothing to fear.

We beg all of you to be compliant. We surmise that 99.9% of our readers have no issue. But, it is all of our responsibility to remain diligent to document our runs honestly and accurately.

The Enhanced Ambulance Billing Services blog is brought to you as an educational outreach by Enhanced  Management Services, Inc.  At Enhanced we provide third-party, ground ambulance billing services to Fire/EMS agencies across the United States.  To learn more about what we do, please visit our website at www.enhancedms.com and click on the “Get Started” link located on any landing page.

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