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5 Revenue Optimization Tips for EMS Billing

November 4, 2022

Your facility can be an excellent provider of emergency medical services but still lose money to revenue cycle mismanagement –and you may not even realize it is happening. Adopting healthy practices is essential to ensure accurate and timely claims, reduce accounts receivables, and increase cash flow. 

Optimizing your revenue won’t just impact your bottom line. It also allows you to make work more manageable for your staff and payments easier for patients. Below are 5 tips on how to optimize your revenue. 

Learn Your EMS Billing Code Structure and Modifiers

Accurate claims submissions are only as good as the billing team handling them. Skilled and experienced billers understand how to review a PCR (patient care report) and accurately determine medical necessity and level of service. Any error may result in denials, delays, and increased accounts receivable.

All insurance providers, including Medicare and Medicaid, reimburse for ambulance and emergency medical services. However, this involves detailed documentation of unique codes and modifiers, including descriptions for modes of transport (ground, water, fixed-wing, or rotary-wing). 

coronis health ems medical workers transporting patient on stretcher

EMS ambulance billing relies on recorded documentation. Healthcare providers should record correct clinical documentation during a case for reimbursement. Moreover, coding and billing are strictly based on this recorded documentation, so the documentation must be complete and accurate.

The CPT codes for ambulance transportation:

There are seven categories of ground ambulance services (both land and water transportation). These codes are based on the patient’s condition at the time of transport as well as services rendered.

A0425 – Ground mileage, per statute mile

A0426 – Ambulance service, (ALS), non-emergency transport (Level 1)

A0427 – ALS (Level 1), Emergency

A0428 – Basic Life Support, Non-Emergency

A0429 – Basic Life Support, Emergency

A0433 – Advanced life support, level 2 (ALS2)

A0434 – Specialty Care Transport (SCT)

Modifiers are two characters that represent origin and destination, and they are designed to show the origin first and the destination second:

Examples of modifiers for Ambulance Transportation

D – Diagnostic or therapeutic site excluded P or H when these are used as origin codes

E – Residential, domiciliary, custodial facility excluded 1819 facility

G – Hospital-based ESRD facility

H – Hospital

I – Site of transfer between modes

J – Freestanding ESRD facility

N – Skilled nursing facility

P – Physician’s office

R – Residence

S – Scene of accident or such acute event

X – Intermediate stop at physician’s office along the way to the hospital

Examples of second modifiers to be included after the origin and destination modifier. These can include but are not limited to:

CR – Related to a catastrophe or declared disaster

GA – ABN was required and obtained

GM – Multiple patient modes of transport

GW – Hospice patient, unrelated to the hospice diagnosis

GX – ABN was optional and obtained

GY – Service that is statutorily excluded

GZ – ABN was required but not obtained

QJ – Incarcerated patient

QL – Patient pronounced dead after ambulance called

QM – Under the arrangement

Use Technology to Improve Billing Accuracy and Efficiency

You may have team members doing highly repetitive tasks as a part of revenue cycle management, such as follow-ups on claim status, creating a patient statement, or verifying eligibility. Various technologies can easily be utilized to take these tasks and automate them, freeing up members of your team to focus on more complex and value-adding tasks. 

With digital tools at your disposal, you can simplify workflow and optimize timelier reimbursements while you avoid the inefficiencies and inaccuracies that are associated with manual paper processes. By leveraging technology such as EMS billing software, you will be able to automate your revenue cycle management processes, helping organize claims to maximize the efficiency of your staff while ensuring claims that need more attention get handled quickly.

Understand Your Local and State EMS Billing Regulations

Each state will have its own administrative codes and regulations that do more than set standards for urgent care. These regulations also set the requirements for licensure, certification, and recertification of ambulance suppliers, vehicles, and personnel to operate within the United States. 

Laws will also vary from state to state or within a state (for example, as stated by CMS, only in some jurisdictions is an EMT-Basic permitted to operate limited equipment onboard the vehicle, assist more qualified personnel in performing assessments and interventions, and establish a peripheral intravenous (IV) line. 

All these factors affect billing guidelines, and billers must ensure that the bill meets the standards of compliance. Billers typically must follow guidelines laid out by the Health Insurance Portability and Accountability Act (HIPAA), as well as their local and state requirements.

Submit Insurance Claims Accurately and on Time

The sooner a claim is submitted, the quicker you can get reimbursed by the insurance provider. One way to ensure quicker and more accurate claim submission is through technology.

Electronic claim submission is one digital tool you can rely on to facilitate the reimbursement process. Submitting claims electronically will help streamline your billing operations and increase cash flow. By filing claims electronically, you can:

  • Increase accuracy and avoid claim rejections
  • Track claim status
  • Cut down on paperwork
  • Decrease overhead costs
  • Minimize disruptions to your cash flow

Consider Outsourcing Your EMS Billing Services

Partnering with an EMS billing services vendor is one of the best moves you can make to improve your revenue cycle management.

Outsourcing EMS medical billing services ensure you have certified professionals who engage in regulated, proven methods of obtaining prior authorizations, accurate charge capturing and coding, claim submission, denial and A/R management, and collection. The effective utilization of a revenue cycle team creates the centralization a healthcare facility needs to meet the challenges the industry presents with enormous amounts of data, changes, and regulations.

Medical billing and collections are critical to the survival and growth of any facility. A skilled medical biller is able to efficiently increase collections and reduce the revenue lost due to denials. In addition, a reputed medical billing company can also help reduce the burden of collections.

EMS medical billing is a complex process where anything can go wrong. From coding errors and processing delays to dealing with insurance companies and tracking unpaid patient accounts, your in-house billing staff has to juggle many tasks and also manage patient care.

Hiring a professional medical billing company can reduce many of these time-consuming tasks for you and your staff so you can focus more on patient care. The billing company will manage denials and appeals and use proven billing and collection strategies to reduce outstanding accounts receivables and optimize collection results.

Coronis Health Offers EMS Billing Solutions 

At Coronis Health, we recognize the need for your services and respect your roles as frontliners. While you are committed to saving lives, we are committed to protecting the resources that allow you to do what you do best.

Specifically, Coronis provides the following services:

  • Customized billing services
  • Delinquent accounts collection
  • Follow-up procedures
  • Staff training
  • Audit services
  • Patient services

We offer superior medical billing and technology innovation, integrating our services with your needs. We have 35+ years of experience to tailor EMS billing solutions and offer more than just medical billing. 

We go beyond your expectations with the latest technology, forward-thinking, and robust business intelligence. We grow with your processes and provide you with the services that maximize your revenue cycle management. 

We understand your needs, build trust, and gain a firm perspective of your facility’s goals, mission, and vision. Trust us to create a revenue cycle management team focused on your success.

Interested to learn more? Request your free financial checkup and find out why Coronis Health is the optimal choice for your healthcare facility. 

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