EMS Billing & Compliance Updates from abc360 Conference

Approximately 500 professionals from across the EMS billing and compliance sector convened in Hershey, Pa., Oct. 17—19 for PWW Media’s abc360 Conference and XI Executive Institute. The event is one of the largest learning opportunities dedicated solely to compliance in the EMS field.

PWW Media, an affiliate Page, Wolfberg & Wirth, LLC, provides MES compliance solutions including manuals, toolkits, training videos and educational webinars, in addition to hosting a full schedule of conferences and events throughout the year.

The abc360 educational sessions were hosted by PWW’s experienced staff of compliance and revenue experts. Doug Wolfberg opened Tuesday’s general session with an update on Medicare and reimbursement. The Centers for Medicare and Medicaid Services (CMS) has imposed its 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) on prehospital care in order to facilitate payments and reduce fraud, but the rigidity of the coding used to describe patient condition has been a pain point for many EMS agencies.

Using Medicare data provided by CMS (the most recent year available), Wolfberg stated that in 2015, a full 10% (about 123 million) of all Medicare claims filed by EMS were denied. Of those, 3% are appealed, and the backlog of pending appeals would take 11 years for CMS to clear if there were no additional appeals added to the load. This revelation procured a collective groan from the abc360 audience.

The solution? Better documentation at the first stage of the claim. “You really got to knock it out of the park the first time,” Wolfberg said. Most importantly, “your ICD-10 code must always be supported by documentation in the PCR.”

For tips for providers on writing better patient care reports, read EMS billing expert Grant Helferich’s ongoing series on EMS Insider.

There were several important trends in reimbursement identified for abc360 attendees:

  • Reimbursement for mobile integrated healthcare (MIH) is growing. As more states come up to speed with MIH and community paramedicine, CMS’ acceptance and reimbursement rates will continue to rise.
  • Healthcare debt continues to rise. Collections are becoming more of an issue for EMS agencies, and we should expect to see new developments in consumer protection related to this.
  • Healthcare mergers are becoming more frequent. Mergers between large hospital systems means more inter-facility transports for EMS–another reason to have your knowledge of ICD-10 codes dialed in.
  • Meaningful use of data. This trend is not specific to EMS, though it is becoming increasingly important. In order to better make the case for federal reimbursement, data must drive our patient care.
  • Increased enforcement. Fraudulent claims hurt more than the agency that files them. Increased instances of fraud have caused federal regulators to review and audit EMS claims with more frequency.
  • Changes to the Affordable Care Act (ACA). Some commercial insurers have started to pull out of the ACA’s health exchanges as they find the system to be less affordable than promised. We can expect the results of next month’s elections to influence further ACA revisions and reaction from CMS and private insurers.

These trends guided the educational program for abc360. General sessions included an update on patient privacy, with important considerations for handling body camera footage, data breaches, encryption, updates to the Health Insurance Portability and Accountability Act (HIPAA) and its enforcement, security of cloud-based vendors, and how to handle photos taken on providers’ personal devices (hint: protocol, protocol, protocol).

PWW’s suggested action items for EMS agencies addressing privacy and HIPAA issues for 2017 are:

  • Conduct a risk analysis
  • Prepare a list of business associates and check off business associate agreements (BAAs)
  • Have a contingency plan for malware attacks
  • Audit your patient access process
  • Deal with cellphone use
  • Consider cyber insurance

Compliance was another issue that packed the main hall, as PWW’s Steve Wirth focused specifically on refunds for overpayment and how to navigate the 60-day overpayment rule. Breakout sessions over the course of the conference included clinics on emergency and non-emergency coding, successfully working with Medicare Administrative Contractors (MACs), payment and compliance issues for commercial payers, revenue cycle management and documentation auditing.

For more information about abc360 and upcoming PWW Media events, visit pwwmedia.com

Kristina Ackermann is the web editor of JEMS.com and EMSInsider.com. Reach her at kristinaa@pennwell.com.

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