Working Together. Merging Call-Intake, Dispatch, Operations and Billing. Rick Keller Fitch & Associates, LLC

Merging Call-Intake, Dispatch, Operations and Billing Merging CallCall-Intake, Dispatch, Operations and Billing Various parts of an organization must...
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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

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Treatment provided Patient demographics (emergency)

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Third party liability

„

– Name, SSN, Address, DOB, Insurance – Auto, workers comp, liability

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Why closer facility was bypassed, and why interfacility transfer needed Physician certification statements

Patient Account Services „ „ „ „

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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 „

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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 „

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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 „

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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)

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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]

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Merging Call-Intake, Dispatch, Operations and Billing

Download Presentation at www.fitchassoc.com

Rick Keller Fitch & Associates, LLC [email protected]

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