Financial Pressure with Positive
The hospital based medical transport program in this case
was experiencing substantial financial duress and had a
number of compliance risks prior to the transition. Program
leadership was under pressure from the sponsoring hospital
leadership to achieve a neutral financial position. Program
leadership engaged an outside consultant to review the
performance. The findings included compliance concerns, as
well as, poor reimbursement performance.
The hospital based medical transport program operates both
air and ground medical transport services within a defined
geographic area, serving the sponsoring hospital and other
institutions in the region. The program transitioned its
billing and reimbursement process to Quick Med Claims (QMC)
in the fall of 2009. The billing and reimbursement process
for the operation was historically handled by the Central
Billing Office (CBO) group at the sponsoring hospital. The
reimbursement performance was below the industry benchmarks.
The program completes more than 30,000 ground transports and
1,000 air transports annually. The transports include a
typical mix of scene responses and interfacility transports.
the implementation process, the QMC team identified several
opportunities for improvement within the billing and
The CBO was experiencing declining reimbursement
performance over a multi-year period prior to the
It appeared that the CBO did not have medical transport
specific protocols in place, including defined processes
and established benchmarks for billing.
The accounts receivable management process was poorly
organized and provided incentives for staff to focus
only on the "low hanging fruit." The CBO quickly moved
claims of to a precollection process that was both more
costly and less Patient friendly.
Some of the processes used by the CBO were not fully
compliant with all of the applicable regulations. Prior
consultants had identified several risk areas that
needed to be addressed.
The CBO was experiencing significant staff turnover and
the transport program had multiple primary contacts
within a short period of time.
There was little to no feedback for program leadership
relative to the billing and reimbursement process (and
its impact on operations).
The QMC team worked with the client team to make a series of
changes in the billing and reimbursement process:
QMC assumed primary responsibility for the AMS billing
and reimbursement process in early 2009.
The QMC team completed the billing and reimbursement
process in turnkey fashion; however the team used
billing software that was deployed on the Client's
The QMC team worked direct with the Client hospital
compliance leadership to develop a compliance program
specific to the medical transport operations.