How to Avoid Compliance Issues in Billing for Ambulance Services?

How to Avoid Compliance Issues in Billing for Ambulance Services?

Billing for ambulance services must adhere to a number of regulations. Unfortunately, most of the billers do not have an adequate knowledge about the existing regulatory framework or the regular updates on it. Such a lack of knowledge heightens the chances of serious compliance issues during ambulance services billing.

Compliance issues in the form of false claims, failure to satisfy Medicare audit requirements, erroneous billing, among others are rampant in ambulance services billing. This thins the chances of claims getting reimbursed without much friction. Billers must be at par with the key criteria to avoid facing such compliance issues.

Here’s a look at those criteria that will help avert compliance issues in billing for ambulance services.

Avoid Compliance Issues in Billing for Ambulance Service

Signature of the Beneficiary

Medicare mandates that all the claims for ambulance services must bear the sign of the beneficiaries, that is the patients. A patient may not be in the right physical or mental state to sign. In such cases, any representative of the patient, such as a family member, a power of attorney, or a representative payee can sign on the patient’s behalf.

Situations can arise when a patient has no representative or if the latter disagrees to sign. Medicare rules allow an ambulance crew member to sign a statement and then obtain a signature from the person who receives the patient. However, both the signatures must be done on the same date.

Medicare rules make the provision of lifetime signatures. This means that a patient’s signature on an assortment of emergency care benefits is valid for a lifetime.

Avoid Compliance Issues in Billing for Ambulance Service

Establishing Medical Necessity for Ambulance Services

This continues to be one of the biggest reasons spurring compliance issues during ambulance services billing. Ambulance transportation must adhere to a certain set of medical necessity guidelines. But such guidelines are quite vague and very difficult to meet.

For instance, the CMS guidelines state that an ambulance transport is considered as a medical necessity when any other transport will endanger the patient’s life. However, it is not always possible to ascertain this fact during emergency care.

Inadequate medical documentation from the ambulance crew has been a major headache for billers. Most of the times the patient care report does not adequately state or detail why a patient needed an ambulance transport. This hinders the ability of billers to enter the level of specificity required for ICD-10 coding.

Avoid Compliance Issues in Billing for Ambulance Service

Billing for Advanced Life Support

This is another serious compliance issue that is the result of using life support (ALS) codes even though they are not applicable.

Most of the time, medical billers adjudge 911 calls billable for ALS services if the calls are answered by an ALS paramedic crew. Such an error is interpreted as upcoding which is a severe compliance breach in the medical billing and coding field.

As a matter of fact, just the presence or a response from an ALS crew cannot justify ALS assessment for billing. An emergency call for ALS services must fulfill the dispatch protocols of the EMS system.

Conclusion

It is evident that ambulance staff must have deep-dive knowledge into ambulance-specific documentation and signature best practices. Medical billers rely on the specificity of information in the PCR to properly bill for the services. However, such knowledge is vast, and it will interfere into the care quality rendered by an ambulance crew. This is why it is essential that medical care enterprises rely on the expertise of third-party ambulance billing service providers. They have the right expertise and experience to deal with the intricacies of ambulance billing and avert compliance issues.

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