Shorter Timelines = Greater Dollar$
The time between…
Rising costs and stale reimbursement is causing everyone in the EMS industry to take a long hard look at the bottom line.
Today we’ll be focusing on three key parts of the billing timeline.
Do you know what the time is that lapses between the incident and reimbursement for the incident?
Lapses in time in three distinct areas can have a very negative affect on your EMS agency’s overall cash flow. Let’s take a look.
1. Incident to PCR
While most EMS systems have specific guidelines in place regarding the amount of time an EMS field provider is allowed to pass from the date/time of an incident to complete a Patient Care Report; that doesn’t always mean that the PCR is completed within that timeframe.
We’ve seen some EMS systems require the completion of a PCR anywhere between 24 upwards to 72 hours following the incident and yet many providers continue to push the envelope and just refuse write the PCR in a timely fashion.
Certainly, we understand that there may be extenuating circumstances such as busy tours of duty…simply times when crews have a tough time meeting the deadline for PCR submission. However, we assert that this is one of the top key elements in being certain you are on the road to conducting the most effective ambulance billing program you can put together.
With every hour that ticks off and every day that passes between the actual time/date of the EMS incident, the window of opportunity to obtain necessary information and quickly resolve the resulting claim for payment by the insurance source slips away.
Plus, if you are reading this and you are an active EMS provider; just think about how much easier it is to write more complete and accurate information into your PCR when the incident is fresh in your mind.
2. PCR to Billing Office
How much time passes between completion of the PCR by the EMS provider until the PCR reaches the billing office? You need to know this.
PCR’s locked away either in a locked box, if you’re completing paper charts, or inside of the hard drive of your computer, if you use an ePCR application are not generating your Agency any money!
Once the EMS provider completes the PCR there should be an immediate review of the chart with the intent of determining if all the requirements have been met in order to move the PCR along in the cycle and ultimately to the EMS billing officie.
Time is money in this game!
Your billing office cannot maintain sufficient cash flow for your EMS agency if they don’t regularly receive the PCR’s to make the process go. Think of your EMS agency as a big steam locomotive. Without the coal to stoke the boiler that steam engine is not going to turn a wheel.
The same goes for your EMS billing program.
The PCR’s are the fuel. Movement doesn’t begin in the EMS billing arena until the PCR arrives and all the elements that must be in place pass review by the biller who then must create a claim and deliver it to the payer source (Medicare, Medicaid, Commercial Insurance, Contracted Payer and/or the Patient.)
Any billing office that knows what they are doing and does it well will constantly stay on top of this and push to receive fresh and relatively recent PCR’s complete with supporting documentation in order to get moving with the billing process.
3. Billing Office to Payer Source
Okay, so your street crews always complete their PCR’s immediately following an incident. Your QA/QI process is rapid and efficient and the PCR reaches your billing office in warp speed. Now it’s up to the billing office to move quickly.
Do you know how long it takes your billing office to bill out a claim from the point that the PCR is received in their hands? If you do great! If you do not know, then you need to find out.
Chances are, your cash flow is terrible if the billing office has a significant amount of unbilled claims either in their billing system not submitted or waiting to be entered into the system.
Plus, if claims aren’t being generated in a timely fashion using every modern means of claim submission, every day brings a lesser chance of your EMS agency receiving the optimum amount of reimbursement that you deserve to collect. Think about it…people disappear, insurance companies impose submission deadlines, insurance coverages change, information gets lost in the shuffle.
Insist that your billing office- in-house or outsource- share their timeline from PCR to payer, with you. In addition, insist that the billing office become transparent and report to you periodically what the PCR to Payer gap is, on average. Their hesitation in providing that information should raise a red flag in your mind.
Ask your billing office if they are submitting claims electronically when possible. Is the billing office tapping into electronic resources to determine claim status? Are they acting quickly to collect every dollar that your agency deserves to receive?
Take a Good Look
There you have it. We’ve given you three key timelines to review in order to put your ambulance billing program back on track. Start shrinking those timelines today to put your EMS agency on the road to billing success!
