Navigating Through Complexities of Billing for Ambulance Services

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Dynamic healthcare reforms, changes in medical codebooks, frequent updates in ambulance service-related regulations from CMS are some of the key factors that invite complexities in billing for ambulance services. Such complexities cause frequent errors in claim files. As a result, erroneous claim files cause frequent claim denials for ambulance service providers.

In this blog, we will highlight the top four factors that render ambulance billing services extremely complex.

Lack of Billing Precision

Ambulance billing is not always done on definitive care given to patients. It is because emergency medical care is given to patients on the basis of their apparent condition. 

Their underlying ailment and the following treatment can be different from their apparent illness. This is why the final billing may not tally with the actual treatment provided. There are chances that ambulance service providers may get underpaid because of such imprecise billing.

Inappropriate Usage of Code Modifiers

Ambulance billing involves using very specific code modifiers. Such specificity added to specific medical codes that identifies various anatomical parts makes ambulance billing all the more complex.

Billers must ensure using correct modifiers that identify the origin and destination of an ambulance trip. It is critical that modifiers are rightly placed by the Health Care Procedure Coding System code that is billed on the claim.

Any slip up in modifier correctness and placement will result in either a prolonged claim processing time or its outright rejection.

Missing Mandatory Signatures

Patients’ signatures testify the fact that they have received ambulance service. Therefore, it is absolutely critical that ambulance service providers get their patient care reports and physician care statements signed by either patients or authorized representatives.

In most of the cases, such a critical step is overridden by the urgency to tend to patients. As a result, absence of signatures holds up the entire file claiming process. 

At times, patients may refuse to give an authorizing signature that is critical for Medicare reimbursement. In such cases, service providers can hold patients responsible for payment. However, if patients again decide to have Medicare pay the bill, service providers must provide this option within the claim file time period stipulated by Medicare. The whole process involves lot of communication to and fro. It results prolongs the process of claim filing and reimbursement.

Complex Medicare Claim Rules

Medicare happens to be the biggest payer of ambulance services bills. It is also a payer with the greatest number of complicated rules. Such rules include stringent claim filing period, retroactive eligibility, and Medicare managed care. Any instances of errors in medical billing invites severe penalties from Medicare.

Different US states have different Medicare rules pertinent to billing for ambulance services. This compounds the existing billing complexity. 

Parting Note

Ambulance staff must undergo rigorous training on ambulance-specific coding. They must stay updated with the frequent changes in regulation standards. The crew must prioritize fulfilling all the formalities required for an accurate documentation for claim files. However, such prerequisites will come in the way of them providing quality care to patients. Outsourcing to qualified ambulance billing service providers takes away the headache of fulfilling the nitty gritty of billing. This allows the crew to concentrate on their core duties without having to worry about service reimbursement.