Mobile Integrated Health – Community Paramedicine Show Me the Money!

Mobile Integrated Health – Community Paramedicine Show Me the Money!

By Kim Sutton, BSN, CMTE *

History of MIH

Mobile Integrated Health and Community Paramedicine are models of healthcare delivery that utilize trained medical professionals that provide care to patients in their homes and communities.  Historically, this was designed for rural health needs. Existing programs of MIH work to promote wellness and health to the patients, decrease remissions into the hospitals, reduce the EMS frequent user transport, and Emergency Department visits in rural and urban areas. Treatment in the comfort of your home by trained professionals has exploded since the global pandemic.  

COVID 19

The pandemic impacted everyone in all situations and held no discrimination to its victims. Globally this paralyzed economies, exports, imports and challenged Healthcare in every aspect.  MIH was positioned with an opportunity to serve the community outside the hospital and excelled with the impact it had on the community. 

CV testing is something that everyone has had to do once the Pandemic started. MIH teammates at the local program in NC worked diligently to screen patients for COVID. In a time that everyone was required to stay at their houses MIH was at the besides of thousands of patients. During this time people needed treatment but were paralyzed with fear in many facets. MIH set the path to treating patients and did it successfully. The local program in NC completed more than 20,000 visits in the second year of the pandemic. 

Billing for MIH

Billing versus reimbursement is the facing question. As we say in the RCM business, you can bill for anything, will you get reimbursed is the question. Billing for MIH can be done utilizing the code AO998.  This is a code that is defined by CMS as treat and no transport. Reimbursement for the services is the question for most programs. I have had the opportunity to work with the local program in my area that utilized the HCPC code for MIH services and are receiving reimbursement from commercial payors. Billing and reimbursement for this program was initiated in 2018. At that time reimbursement was approximately 20%. This has increased to 40 to 50% reimbursement for specific payors.  

What about ET3

This model Emergency Triage, Treat, and Transport (ET3) is a voluntary five-year payment model that addresses health care needs of Medicare Fee for Service beneficiaries. Medicare guidelines have historically only allowed reimbursement for emergency ground services. However, in Spring of 2020 which also correlates with the start of the Pandemic CMS expanded the list of allowable destinations for ambulance services if enrolled. The key for disseminating is transporting non emergent patients and treating patients in their community.  

Show Me the Money

Each of these models reviewed for specific needs to a growing program. Reimbursement in a time of crisis was increasing. Not only was the demand for services increasing but the reimbursement on commercial payors and the Federal government were providing payment for person centered care that encourages appropriate utilization of services. 

What are the Next Steps

Next steps for MIH…. REGULATION!!  Currently there are no state or offering EMS regulations set into place for this scope in the state of NC. If regulations are placed this will impact billing and revenue.  Another point is to engage at the state level. Lobbing in the upcoming year to support regulations that protect the practice and assist in driving revenue will support the positive movement of MIH.  It is imperative to speak up for person centered care within your community now more than ever. Whether you are the dispatcher, first responder, driver, coder, biller, lobbyist, or legislative leader. Everyone can make an impact that will continue to place the care of patients as collective focus for all.

*Kim Sutton is a new member of Quick Med Claims as a Client Success Manager. She has been in the Revenue Cycle Industry for 8 years with a hands-on approach with her clients for reimbursement, outreach, and marketing. In addition to RCM, she is also a Critical Care RN and continues to remain active with patient care with 25 years of experience.