The air medical services (AMS) program in this case was
operating on solid financial footing; however program
leadership was concerned that the billing and reimbursement
performance was below area benchmarks.
The AMS program transitioned its billing and reimbursement
process to Quick Med Claims (QMC) in the fall of 2013. The
billing and reimbursement process for the AMS operation was
historically handled by the Patient Business Services (PBS)
group at the sponsoring hospital. The reimbursement
performance was below the industry benchmarks.
The AMS program completes more than 500 patient transports
per year, including a mix of scene responses and
interfacility transports. Program leadership and hospital
leadership sought additional feedback/benchmarking through
their aviation management partner. An independent consultant
was engaged to evaluate the billing and reimbursement
performance. That consultation resulted in confirmation of
the suspicion. Hospital leadership elected to outsource the
billing and reimbursement process..
During the implementation process, the QMC team identified
several opportunities for improvement within the billing and
The reimbursement per transport was below $4,010. This
performance is well below the national and regional
There were a number of hospital driven processes that
resulted in a negative impact on the billing and
reimbursement performance, including use of the hospital
billing software (not geared toward transport).
The clinical documentation quality was solid, but some
opportunities for improvement were identified.
Some of the processes in place were less than efficient
and needed to be adjusted to allow for maximizing the
reimbursement per transport.
The sponsoring hospital resources committed to the AMS
program billing and reimbursement were well beyond the
benchmarks, indicating less than optimal efficiency in
The charge structure was not consistent with industry
best practices and the levels were well below the range
of charges in the region.
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. The majority of the processes
were changed to the QMC operating standard.
The QMC team continues to work with the leadership at
the sponsoring hospital to adjust the processes in order
to ensure compliance, maximize reimbursement and deliver
quality customer service to patients and families.
The QMC team provides regular feedback to AMS program
leadership regarding the quality of the documentation
and has offered educational programming to enhance the
There was an initial charge structure adjustment at the
time of the transition and the sponsoring hospital
leadership plans to complete an additional adjustment in
2014 in order to make the structure and levels
consistent with the prevailing practices.