(2 min read) As the demand for Medicare Advantage and Medicaid managed care grows, so do the rules and regulations — which means more challenges for the billing department. What are the best billing practices for submitting claims?
Here are five survival strategies for your billing department:
- Utilize Verification Software — Every January, patients can change their providers. Make sure you're using good verification software to receive the most updated information regarding which provider your patient is with now.
- Cross-train Other Departments — The three components of emergency transportation, Dispatch centers, field operations, and billing, can support each other’s goals. If possible, see if dispatch can verify an insurance provider. It would be more effective for them to know, for example, that a NEMT provider will need a prior authorization.
- When Possible, Obtain Prior Authorization for Non-emergency Transport (NEMT) — NEMT is covered if there is a prior authorization or is contracted with the transportation provider before services occur. Reimbursement is significantly more challenging if you seek it through retro-authorization.
- Know Your State’s Requirements and Definitions — Centers for Medicare and Medicaid Services (CMS) is a great resource to learn your state’s requirements and definitions. For example, while emergency transportation is usually covered, what is considered emergency transportation vs. NEMT? Consult CMS for answers.
- Follow Compliance Rules — Medicare and Medicaid plans can and will audit your organization. They define fraud as “an intentional deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit to himself or another person.” Fraud can occur, for example, if you bill for mileage and the recipient wasn’t in the vehicle.
Watch Now: Billing Survival Strategies: Medicare Advantage and Medicaid Managed Care
For a more in-depth look into how your billing department can manage the demand for Medicare Advantage, watch our webinar with EMS billing expert, Maggie Adams: Billing Survival Strategies: Medicare Advantage and Medicaid Managed Care.