An Opportunity for Improvement

Air Medical Service (AMS)

The air medical services (AMS) program in this case experienced a leadership transition in 2012. The new leadership identified revenue cycle management as an opportunity for improvement. AMS leadership engaged an outside consultant to review the revenue cycle management performance.

Situation

The AMS program is structured as a consortium and the billing and reimbursement was historically handled by the Patient Financial Services (PFS) group at one of the sponsoring hospitals. Quick Med Claims (QMC) assumed responsibility for the billing and reimbursement process in 2013.

Background

The AMS program completes more than 4,000 patient transports per year, including a mix of scene responses and interfacility transports. The leadership elected to transition a portion of the transport operation (1,200 transports and several bases) to an outsourced model.

Assessment

During the implementation process, the QMC team identified several opportunities for improvement within the billing and reimbursement process:

• The reimbursement per transport was below $5,200. The performance was well below the national and regional benchmarks.
• There were a number of hospital driven processes that resulted in a negative impact on the billing and reimbursement performance.
• There were issues related to licensure and provider numbers that had not been identified by the PFS group.
• Program leadership was unable to obtain important financial information to support operational decision making.
• The charge structure was not consistent with the industry best practices and the levels were well below the range of charges in the region.

Recommendations

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 processes were changed to the QMC operating standard.
• QMC worked directly with program leadership to support resolution of the licensure questions and secure the appropriate provider numbers.
• QMC constructed a set of monthly reports to support management decision making and provides ad hoc reporting for specific queries.
• The QMC team provided clinical documentation training for the entire operation. The QMC team provides regular feedback to AMS program leadership regarding the quality of the documentation.
• There was an initial charge structure adjustment at the time of the transition. QMC provides regular feedback to program leadership to support annual evaluation of the charge structure.