Ambulance billing is a highly-complex process subject to regulatory compliance and the pressure to get it right to avoid over-charging clients and patients and, worse, accidentally violating the law.
Unlike other medical specialties, the care provided by the emergency medical personnel of an ambulance service is not based on a definitive diagnosis. Instead, patients often have to be treated based on their apparent condition. As a result, the coding and billing for services rendered are based on the patient care report filed by the ambulance crew as well as the run sheets filled out at the time a patient is picked up. Accurate documentation in the patient care report is absolutely critical, especially for compliance and insurance claims. That can make all the difference in the world between claims and payments being processed smoothly or having them stuck in limbo and the patient potentially getting stuck with a bill that would have been covered by insurance had the coding and billing been handled properly.
So why is ambulance service billing so complicated?
While most of the codes for billing correspond to parts of the body, there are also modifiers specifically for ambulance services, as there are for other healthcare providers. The specific modifiers for ambulance services identify the origin and destination of the ambulance trip which must be submitted on all ambulance claims. The modifier is placed next to the Health Care Procedure Coding System (HCPCS) code billed. The incorrect use of modifiers is what leads to longer processing time and even denial of services.
And that’s not all.
For billing to be compliant, it’s vital to have valid signatures on all documentation, along with the inclusion of Advance Beneficiary Notices and Physician Certification Statements. This is where knowledge of beneficiary signature rules comes in – there are complex issues revolving around required signatures, including who can sign on the patient’s behalf and when. All of this can affect the billing.
CAC designation is the key to accurate billing.
As you can see from all the factors that can affect ambulance services billing, it’s crucial to have staff trained and registered as Certified Ambulance Coders (CAC).
At Medstar, our billing staff features certified coders fully trained and experienced in coding practices, HIPAA compliance, patient care reports, payer issues, and follow-up processes. CAC certification means our billing staff is knowledgeable and current with all industry rules and regulations to ensure fair, accurate, and efficient billing for all parties involved.