Ambulance Billing Policies and Procedures Ambulance policies and procedures are essential in order to meet the compliances in the healthcare industry today. Connect with us info@medicalbillersandcoders.com, Toll-Free : 888-357-3226 Click Here: https://www.medicalbillersandcoders.com/articles/best-billing-and-coding-practices/ambulance-billing-policies-and-procedures.html #ambulancebillingpolicies #ambulancebillingprocedure #emsbilling #ambulanceservices #ambulancebilling #cms

1. Medical Billers and Coders

2. Policies and procedures are essential components to have to be
able to meet the compliances in the healthcare industry today.
These documents provide the Compliance Officer, executive
management and the workforce with an understanding on what
is expected and how to operate.
Given the fraud that has happened in the ambulance service
healthcare delivery, vigilance is even more now from the
Centers of Medicare and Medicaid (CMS). The first document
that should be developed and distributed, at least among staff,
should be the Standards of Conduct or Code of Conduct. This
document must integrate:

3.  Commitment to compliance with all federal and state
standards by all staff from top down
 The organization’s goals, mission and ethical requirements –
which should be clearly be informed to ambulance crew every
3 months at least.
 Certain basic standards of performance from all members of
the ambulance service right from management to workforce.
However, when it comes to Ambulance billing where fraud is
eminent certain Policies and procedures should be maintained. In
order for the policies and procedures to be effective, they must
be tailored to the operations of the provider and be supported
from the top-level management that throughout the
organization. “Boiler-plate” policies and procedures will not work
except as guidelines.

4. Policies should cover:
 Billing for items or services never provided: The transport
must be medically necessary and reasonable. Moreover, the
mere presence of a physician’s order for transport by
ambulance does not necessarily prove or disprove whether
the transport was medically necessary.
 The documentation that provides the strongest support to
establishing medical necessity is the patient care report (PCR),
which is essentially a medical record documented by the
treating emergency medical technician (EMT) or other
provider, detailing the patient’s condition and interventions
performed during the transport. This is very essential for the
Billing team to be able to increase revenues and still not
commit fraud.

5.  Ambulance providers must ensure that transports billed to
Medicare meet certain “origin” and “destination” parameters,
have physician certification statements on file, and are coded
with the correct level of service provided. Any
miscommunication and wrongly coded or entered data during
this process could lead the ambulance provider to either facing
a civil and/or criminal liability.
 The non-emergency side of the ambulance transport industry
which includes what is known as repetitive transportation for
especially patients suffering from dialysis, needs to be more
vigilant and very clear documentation should exist.
 Appointing an individual with a clinical background (ideally a
registered nurse, but at least a paramedic) to conduct a pre-
transport on-site evaluation of the patient.

6.  Regular & Effective training and education should be part of
the policy of any ambulance Billing Service. It is one of the
most important elements of a compliance program, as it helps
the ambulance staff to understand & integrate the policies and
procedures into practice; and also keeps them updated about
new regulations and rules brought in by CMS and other
healthcare providers.
 Zero Tolerance towards fraud: A hotline number which keeps
the channel open for reporting of compliance issues without
any retaliation in line with the zero-tolerance of fraud should
be in place. Without empowerment in place, a truly effective
reporting of compliance issues cannot be ensured.

7. Procedures when Billing in Ambulance service:
Train the communications personnel for different kinds of call intake &
dispatch, and on identifying Medicare repetitive patient transports when
scheduling requests are received.
Screen for initial dispatch process. The process would be used to
evaluate the patient’s condition and make an initial determination of
whether or not the patient meets the CMS definition of medical
necessity.
When on site evaluation is conducted it should be extremely detailed
and include information on where the patient currently resides the
patient’s personal and insurance information; information on the type
and location of the destination facility; and information on the type of
treatment the patient will be receiving at the transport destination.
Onsite evaluation of the patient’s condition is a must and should be
noted in the Patient Care Report as this is very essential for the medical
billers and coders of the Ambulance Service.

8.  For repetitive patients, the evaluator should conduct a short-
form re-evaluation of the patient to ensure their condition
continues to meet medical necessity.
 The compliance officer should continually audit and monitor
the repetitive patients and an accurate list or database of all
current repetitive transport patients should be maintained and
audited.
 Billers need to refer to the Patient Care report, and recheck with
ambulance crew to properly identify the right codes and
modifiers to be employed.

9. The compliance officers must emphasize that Compliance is not
just about abiding by rules and regulations; it also involves
setting up best practices in patient care documentation, billing,
and quality of care so as to bring about a more effective and
efficient Revenue Cycle Management (RCM) Process .

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