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Ambulance Billing: Best Practices to Maximize Revenue

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Ambulance transportation is a reimbursable service when the patient’s health condition is such that using any other transportation method would endanger the patient’s health.

Ambulance services are handled by paramedics and other medical professionals. They are well trained and equipped to carry out the first aid and transportation.  Ambulance Billing and coding are best done by professionals who are certified and trained in this work.

To ensure that no bill is left behind unpaid, it is essential to follow some practices diligently. These best practices will maximize your revenue.

  • Coding should be done based on the level of service provided, not the type of vehicle used. Some examples of ambulance services are (i) Basic Life Support (BLS) transport (ii) Non-emergency Transports, which may be scheduled, unscheduled, repetitive and non-repetitive ambulance trips. They require a physician certification statement (PCS) and rules for obtaining PCS are specific (iv) Emergency Transports (v) Return trip from the ER (vi) Discharge from the hospital.
  • Key data should be collected at the time of call intake. This becomes especially important in the case of non-urgent, non-emergency transport. Medicare and commercial payors require more supporting documentation to process payment for such ambulance transport. The data that must be collected are
  1.                 1. Patient information such as patient’s name, address, phone number, social security number, date of birth, health insurance details
  2.                 2. Certification of Medical Necessity (PCS): There are specific PCS requirements for each type of non-emergency ambulance transport.

Securing proper and complete ambulance billing information at the time of dispatch leads to faster claim reimbursement and lesser rejections.

  • Insurance eligibility verification must be done to ensure that the service is covered by the patient’s insurance.
  • Modifiers are used in ambulance billing also. But for ambulance services, the specific modifiers identify the place of origin and destination of the ambulance trip. This is to be done for each trip. The modifier is to be placed next to the Health Care Procedure Coding System (HCPCS) code. Incorrect use of modifiers leads to longer processing time and possible denial of claims.
  • For billing to be compliant, valid signatures on all documents are essential. Beneficiary signature rules and other rules relating to signatures must be followed in the case of Medicare reimbursements.
  • As with all claims, submit the insurance claim without delay. Check if the payor has received it and follow-up with the payor.
  • Effective denial management strategies must be in place.
  • Payment posting should be done quickly.
  • Internal audit systems will ensure submission of clean claims and consistent cash flow.

Bristol Healthcare Services has 20 years of ambulance billing experience. We follow best practices for all billing and coding services to ensure the submission of clean claims. Our team will do rigorous follow-up with payors. Our Certified Ambulance Coders (CACs) we will ensure that your back-office work runs effectively, and your revenues are maximized.

Talk to an expert and let us forge a mutually rewarding partnership!