To achieve the Triple Aim of improved quality, cost, and patient experience, EMS organizations are increasingly accountable for patients’ quality of care while reducing total costs.
Meanwhile, as industry competition and operational expenses continue to grow, it’s become paramount that they manage high-performing billing operations to increase and accelerate cash flow. Under these evolving conditions, traditional billing approaches are no longer enough to remain competitive and profitable.
6 Common Gaps That Lead to Revenue Leakage
Ambulance billing is unique in that it requires providers to both deliver high quality care and gather billing data at the time of service. New challenges, such as payors mandating more documentation than ever before and high deductible health plans shifting costs to patients, too often lead to lost revenue.
The 6 most common areas within the billing process where gaps occur are:
- Dispatch: Insufficient level of service documented at dispatch.
- Insurance Verification: Lack of prior authorizations for non-emergency trips.
- Coding & Claim Submission: Not enough information to justify level of service and/or meet the level of medical necessity.
- AR Follow-Up: Businesses are not yet accounting for the risk associated with costs shifting to patients with high deductible health plans and related challenges.
- Patient Engagement: Most EMS organizations are still using paper statements, which make it difficult for patients to provide insurance information or pay on time.
- Operational Improvement: Lack of visibility into opportunities for revenue optimization or gaps to address.
6 Best Practices for Plugging Gaps and Maximizing Revenue
In contrast to the traditional billing operations that once powered EMS, comprehensive revenue cycle management (RCM) solutions help mitigate the common gaps that contribute to revenue loss throughout the transport billing process – from dispatch to discharge.
By introducing the following technology-enabled best practices – leveraging the RCM model – EMS organizations can optimize quality of care and maximize revenue.
- Dispatch: Electronic documentation of all actions, interventions and supplies used at the time of service.
- Insurance Verification: Real-time eligibility verification and authorization for non-emergency trips prior to transport.
- Coding & Claim Submission: Compliance-tested coding, leveraging a rules-based engine to scrub for accuracy.
- AR Follow-Up: Automated “claims statusing” to proactively track claims, unburdening your staff.
- Patient Engagement: Electronic payment portal, providing cost transparency and an easy way to make payments.
- Operational Improvement: Tools for data capture and analytics to gain data-driven insights in near real-time.
Do you have the right people, skills and tools not just to optimize your billing processes, but to maximize your cash flow?