Beware of the Compliance Warning Signs!
Big Bucks!
It has always been important for any ambulance billing program to follow the narrow road of compliance. But now more than ever and with big bucks on the line, it’s important that every EMS administrator heed the compliance warning signs.
The headlines tell of those who either turned a blind eye to the need to remain squeaky clean compliant or purposely set out to try to side-step the rules and regulations. The lack of compliance coupled with whistleblower complaints and investigations have resulted in big paybacks totaling in the millions of dollars and in some cases even jail time, not to mention the stigma and shame such allegations can bring.
So, to help you avoid some of these mistakes, here are three warning signs for those that are not intentionally trying to cheat the system and truly want to stay on the up-and-up.
Too Good to be True?
Every ambulance administrator wants their reimbursement program to be successful. Here at Quick Med Claims, we want our clients’ EMS billing programs to soar…but we want them to soar the right way and always with an eye on compliance.
If, all of a sudden, the results seem just too good to be true; then it may be time to take a good hard look by initiating an audit. Now certainly, if you can tie increased performance over time to a new process or a change in billing vendor relationships or even the implementation of a new digital solution for claims processing and support- then good for you! Keep up the good work!
But, if all is the same and no major changes have been made to the way things have been going by way of systems, people power, processes or solutions and overnight it seems that the money is flowing in faster than ever…beware!
At least take a good look. Do an audit (you should be auditing or have an outside source auditing or both, anyway). What’s it going to hurt to pull a representative sample of claims and look at coding, mileage, submissions, denials….both before submitting the claims and after submitting the claim (the denials part, of course)?
Certainly, if a new person(s) or firm has taken over the administration of your billing and the numbers seem to be off-the-charts, at least inquire about their auditing processes. Make double-sure they have the right controls in place – or you have the right controls in place to catch any errors that may pile up.
If all of a sudden, your level of service mix changes, let’s say, from BLS Emergencies to more ALS Emergencies or the payer mix drastically makes a seismic move; it’s time to peer into the belly of your billing program to see what’s up.
If The Benchmarks Don’t Jive…
By now, we’re sure that you’ve learned to talk to others in the ambulance industry. You most likely have friends that are administrators of like-minded ambulance services that serve in similar demographics and scopes of practice.
When you compare general notes, does it seem like your numbers just aren’t adding up the same way their numbers are? Are your numbers way higher (or way lower) than the other guy’s numbers and there seems no logical reason why it should be this way?
So, your average miles per trip is similar, payer mix seems close and you run from the same dispatch protocols as they do, but yet the numbers are so much different…stop now and ask questions.
When you find that your billing office is simply slaying their jobs, then breathe a sigh of relief and tell the other guy he/she needs to do what you’re doing. But if you take a look and there are more questions than answers, take a break, take a look and dig in for answers.
Doing nothing and floating along may just cost you more than you’re willing to pay down the line.
Resistance to Transparency
You find that something just isn’t adding up. You begin to ask questions. You request reports. You request a meeting. Yet, it seems at every turn you’re meeting resistance from your billing office.
If the reports aren’t forthcoming, numbers aren’t adding up and there’s an excuse why your billing office can’t get together with you to answer your questions…then beware!
Frankly, you need a billing office that will provide you with the means to take a look at the numbers when YOU want to look- they’re your numbers! The response to your inquiries should be swift, easy and clear.
Any other response, especially one that seems to resist transparency, is major cause for concern. Now is the time to act and do so with expediency. You deserve the answers to the questions you are asking right away because it’s your neck on the chopping block should something go awry with compliance!
