Revenue integrity is the goal of every billing department. If an agency can achieve this goal, its documentation will stand up to the coverage requirements of federal payers, as well as hold value when audited. These five best practices of patient documentation are the keys to improving revenue integrity, helping you avoid payment delays and sail through audits.
Close Gaps in Documentation Requirements
Is there enough documentation to justify the patient transfer? Can you prove why the patient is being transported by an ambulance and not getting on a bus? This documentation is critical to having revenue integrity and it must detail:
- Reasonableness – what led up to the transport and why the patient is transporting
- Medical necessity – why the patient can’t travel by other means
- Destination – why the patient is going to a certain facility (e.g. proximity, capabilities, patient choice, bed availability, etc.)
Align With the Centers for Medicare and Medicaid (CMS) Emergency Response Guidelines
The Medicare Beneficiary Policy Manual Emergency Response Guidelines states what qualifies an emergency response versus an immediate response. Aligning with these CMS guidelines helps to set a clear standard for everyone in your organization, assuring auditors that your dispatchers are following a logical decision tree rather than making calls on the fly. It adds weight to the documentation discussed above, helping you justify reasonableness and medical necessity so it’s easier to submit a clean claim.
Know How To Bill for an ALS Assessment
Medicare defines an ALS assessment as one performed by an ALS crew as part of an emergency response that was necessary because of the patient’s reported condition. When ALS assessment is completed in accordance with an emergency response, those services are covered at the ALS1 Emergency level, regardless of whether the patient required an ALS Intervention.
Even if you decide an ALS intervention is not required, you can still bill at that ALS1 level of service based on the patient’s conditions and the fact you had an ALS provider on board in the ambulance. But those condition must be present. Knowing this distinction will help you properly bill for an ALS assessment.
Get Required Signatures
Certain forms are federally required to be on file for any claim, in any circumstance, when billing Medicare. Without these signed forms, your claim will not be paid:
- Patient consent form
- Physician certification statement
- Advanced Beneficiary Notice (ABN) of noncoverage (rarely appropriate)
Incorporate Data Validation
Crews need to proactively collect whatever information they can in the field. Data validation features in charting software allow you to set standards for field completion. For example, fields can be required or warning. There are also variations of data validations (clinical, billing, medical legal, etc.). These validations are checkpoints that the crew can complete while the crew has the patient in front of them. Data validations have saved agencies a lot of headaches because they help improve the data coming into the billing department.
Watch the webinar, "Charting the Path to Revenue Integrity: Reducing Reimbursement Delays," to learn more best practices that will help your organization submit clean claims and avoid raising red flags to auditors.