Real-Time Insurance Discovery & Verification Services

Their Mission

Mohawk, the largest privately-owned ambulance service in upstate New York, services six emergency centers, makes 56,000 trips annually and employs a team of more than 250 staff members. Mohawk’s mission is to uphold the highest standard of EMS services with consistent devotion to delivering superior emergency medical care.

Billing staff maintain a vigilant watch over the verification, billing and collection functions at Mohawk. Working together with local hospitals and nursing homes, they have fine-tuned many standard checks and balances processes such as verifying coverage and screening deductibles to reduce eligibility-related rejections before claims are submitted to a payer. The verification team also performs insurance discovery for patients without insurance

The Challenge

Mohawk used a combination of third-party solutions for decades to support their revenue cycle. But each application worked independently and in separate silos. Billers searched across several different systems, payor websites and Patient Care Record (PCR) pages to collate all the various demographic and insurance data necessary to submit each claim.

Key challenges included:

• Too many screens, websites and systems searched by billers to find information and populate a claim 
• High number of lag days waiting for verification, deductible screening and insurance discovery 
• Inability to find insurance coverage to reduce eligibility-related rejections, convert self-pay accounts and collect revenue from the right source

The Solution

To achieve efficiency goals and renovate Mohawk’s insurance discovery process for patients with no known coverage, the agency ultimately switched to RescueNet Billing Pro because: 

• A consolidated view of the electronic patient care report (ePCR) gives billers all of the claims data they need in a single application 
• Fully integrated back-end insurance verification and discovery services with front-end ePCR workflow enables real-time searches versus batch-report processing 
• Demographic Verifier validates patient data and fills in the blanks for emergency transports

The Benefits

• 30 percent improvement in staff efficiency for insurance verification 
• 67 percent less time needed per trip to screen for Medicare deductibles 
• 100 percent elimination of wait times to discover billable insurance for self-pay patients