Merging Call-Intake, Dispatch, Operations and Billing
Merging CallCall-Intake, Dispatch, Operations and Billing Various parts of an organization must converge in order to optimize revenue recovery… recovery…
Dispatch
$
Field
Rules
Billing
Working Together
Effective communication Common language Clear definitions Shared responsibility Understanding of each others roles Accurate documentation Comprehensive quality management
Rick Keller Fitch & Associates, LLC
[email protected]
Page 1
Merging Call-Intake, Dispatch, Operations and Billing
Obstacles
Dispatch vendettas Field sabotage “If only the crews would provide better documentation.” documentation.” “It’ It’s not my job, it’ it’s the billing office’ office’s” “I can’ can’t…HIPAA you know…” know…”
Who Should Do What?
Who has the best and earliest access to the needed information? – Dispatch – Field – Billing Office
Dispatch
Condition at time of transport Emergency vs. nonnon-emergency ALS or BLS ALS 1 reimbursement for ALS assessment NonNon-emergency medical necessity (PCS) Specialty care transport requirements Interfacility justification Prior authorization LongLong-distance transfer arrangements
Rick Keller Fitch & Associates, LLC
[email protected]
Page 2
Merging Call-Intake, Dispatch, Operations and Billing
Caregivers
Reason why ambulance is necessary Patient’ Patient’s condition
– BedBed-confined, symptoms, diagnosis, mental state
Treatment provided Patient demographics (emergency)
Third party liability
– Name, SSN, Address, DOB, Insurance – Auto, workers comp, liability
Why closer facility was bypassed, and why interfacility transfer needed Physician certification statements
Patient Account Services
Rules and regulations Payer requirements Verify coverage FollowFollow-up on missing information and documentation Request letters from physicians and other documents for appeals
Emerg?
YES
NO ALS Indicated?
Immediate response?
YES
NO
NO
ALS 1 $247
YES ALS Indicated?
YES ALS Assessment?
NO
NO
NO YES
NO
BLS $205
NO
ALS Provider?
9- 1- 1
ALS 1 Emerg $390
Rick Keller Fitch & Associates, LLC
[email protected]
ALS Provided?
YES
YES YES
YES NO
Assessment Documented?
ALS 2 Criteria Met?
ALS 2 $565
BLS Emerg $329
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Merging Call-Intake, Dispatch, Operations and Billing
Field
Dispatch 9- 1- 1 Emerg?
YES
NO
YES
Immediate response?
NO
YES
NO
NO
BLS $205
ALS Assessment?
ALS Provided?
YES
YES YES
2
BLS Emerg $329
5
Emerg?
1 YES
NO ALS Indicated?
3
4 YES
Immediate response?
YES
ALS Indicated?
NO NO
YES
NO
NO
ALS 1 $247
Field
NO
ALS Provider?
NO
BLS $205
YES NO
Assessment Documented?
ALS 2 $565
Dispatch 9- 1- 1
NO
ALS 2 Criteria Met?
ALS 1 Emerg $390
ALS 1 $247
YES
YES ALS Indicated?
NO
NO
ALS Indicated?
NO
ALS Provider?
ALS 1 Emerg $390
ALS Provided?
6
YES
ALS Assessment?
8 YES
YES YES
ALS 2 Criteria Met?
9
ALS 2 $565
NO
YES NO
Assessment Documented?
7 BLS Emerg $329
Problems
Lack of documentation Documentation conflict
Rick Keller Fitch & Associates, LLC
[email protected]
Page 4
Merging Call-Intake, Dispatch, Operations and Billing
Dispatch Documentation Problems
Failure to document… document… – Patient condition at time of transport – Immediate response – Need for ALS Assessment
Field Documentation Problems
Documenting “nonnon-emergency” emergency” when criteria met for emergency Failure to document ALS assessment performed Failure to document why closer hospital was bypassed
Contradiction in Documentation
Field documents nonnon-emergency when lights and sirens not used to respond Field documents nonnon-emergency when patient transported without lights and sirens Field documents BLS call when ALS assessment conducted
Rick Keller Fitch & Associates, LLC
[email protected]
Page 5
Merging Call-Intake, Dispatch, Operations and Billing
Patient Accounting Problems
Failure to identify immediate response criteria for emergency Billing emergency based on patient condition Not documenting ALS assessment or intervention on claim
Patient Accounting Problems
Not listing specific ALSALS-2 interventions or I.V. medications on claim (e.g. Epinephrine X 3)
Not documenting specific reason patient needed SCT Not documenting what service was unavailable or why hospital was bypassed
Conclusion
Dispatch, field and billing have to collaborate to achieve optimal reimbursement Documentation is essential Compliance must be proved
Rick Keller Fitch & Associates, LLC
[email protected]
Page 6
Merging Call-Intake, Dispatch, Operations and Billing
Download Presentation at www.fitchassoc.com
Rick Keller Fitch & Associates, LLC
[email protected]
Page 7