Recovering Loss of Revenue from “not at fault” Accidents

When your units get hit by a third party and the vehicle is out of service, are you getting Loss of Revenue for the downtime while the unit is being repaired? Whether you answered yes or no to that question, reading this article will be the one of the most lucrative uses of your time this year. A call comes in and your dispatcher does a perfect job of answering and scheduling the run. The EMT’s jump into the clean, fueled, and well stocked ambulance responding to the call. Then from out of nowhere, a car turns directly into the ambulance’s path rolling through a stop sign. Now what? You have two paramedics stranded on the side of the road who will be spending the next few hours on paperwork and drug testing. In addition, all the drugs and small equipment need to be removed or secured. Hopefully you have another unit to dispatch or your competitor may have already been called. What happens next is key to getting maximum recovery for your losses caused by the accident. Key items that help maximize your recovery from accidents: Educate and equip fleet drivers with the tools necessary to collect key accident...

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Employer-Sponsored Healthcare Spending Soars

A recent report published by the Health Care Cost Institute (HCCI) found that employer sponsored healthcare spending rose in 2016 even thought patients sought less healthcare.  The article found that the average spending per person grew 4.6% in 2016 and has cumulatively grown by 15% since 2012.  The majority of the spending increase was attributed to outpatient service, ER visits, and prescription drugs.  Modern Healthcare published an article about the report which showed that most employers held down their costs by shifting their employees to high-deductible plans.  Many ambulance services have had to shoulder much of the increase costs of employee healthcare in an effort to avoid shifting too much additional expense onto employees.  This trend is projected to continue and encourages employers to offer, and employees to contribute to a health saving accounts as a way to insulate unexpected high deductible obligations.  With the uncertain future what remains of the ACA, we will continue to watch for strategies to help ambulance services to keep healthcare cost increases to a minimum....

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Executive Order on Association Health Plans (AHP)

Yesterday, the White House announced that President Trump has signed an Executive Order that directs the Secretary of Labor to consider expanding access to Association Health Plans (AHP) would give employers the right to form groups in multiple states for the purposes of negotiating health care benefits.  A change would require an change to the interpretation of Employee Retirement Security Act (ERISA).  In addition, the Executive Order directed the Departments of the Treasury, Labor, and Health and Human Services to consider changing several ACA restrictions, including low-cost short term limited duration insurance (STDLI) and Health Reimbursement Accounts (HRAs).  This Executive Order may impact the ACA insurance markets because it may attract the younger and healthier away from current plan groups causing those coverage costs to increase substantially....

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Trump Administration Interim HHS Rule

In a surprising announcement by the Trump Administration late Friday, the Department of Health and Human Services (HHS) the Administration released an interim rule that rolled back the Obama Administration rules regarding the requirement of employer sponsored health plans to pay for “preventative services” which included birth control and abortion procedures under religious or moral objections. The move has initiated legal action by the Attorney General in Massachusetts who announced yesterday that she has filed a suit in U.S. District Court yesterday. Key facts about the interim final rules: The regulations exempt entities only from providing an otherwise mandated item to which they object on the basis of their religious beliefs or moral conviction. The regulation leaves in place preventive services coverage guidelines where no religious or moral objection exists. The Administration is asserting that out of millions of employers in the U.S., these exemptions would only impact about 200 entities. Current law itself already exempts over 25 million people from the preventive-care mandate because they are insured through an entity that has a health insurance plan that existed prior to the Obamacare statute. The regulations leave in place government programs that provide free or subsidized contraceptive coverage to low income...

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Patient Satisfaction and the Collections Conundrum

Emergency Strikes The year was 2001—seems like a distant memory. Expecting our first child, my wife and I were living in Modesto, California, thinking about cradles and nurseries. We were so excited—the little one we’d been expecting was on his way! Excitement quickly changed to deep concern as we learned there were some major complications with the pregnancy and our baby was in serious jeopardy. Life’s pause button was pushed as everything else in the world came to a screeching halt. An ambulance transport and emergency delivery later, we found ourselves in our new home—the neonatal intensive care unit. For the next four months, we worked with medical teams around the clock to slowly usher our new 1-pound, 4-ounce son, Noah (now 15 years old), into the world. Financial Domino Effects This was an incredibly stressful time in our lives. Of all the things that burdened us, one of the most memorable was the nearly $5,000 invoice we received for a specific service. With no clue how we would pay this, I finally worked up the courage to pick up the phone and call the number on the invoice. The provider was demanding immediate payment before sending the bill to...

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Ransomware: A Ticking Time Bomb for Health Care

By Cindy Elbert President, Cindy Elbert Insurance Services, Inc If you’re doing business online, you need cyber-insurance. This fact was never made truer than on May 12, 2017 when 50,000 businesses in at least 74 countries were hit by a ransomware attack code named “WannaCry”. Hackers demanded companies to pay a $300 ransom fee or their files would be published on the Internet. The data thieves targeted mostly hospitals and other medical facilities because their data not only included names, home addresses, addiction histories, financial information and religious affiliations but also disclosed patients’ mental health and medical diagnoses, HIV statuses and sexual assault and domestic violence reports. A gold mine of personal information for those with dark purposes. Two days earlier, a data breach at the Bronx Lebanon Hospital Center in New York compromised the medical records of at least 7,000 people. According to NBC News, “Leaks from the Rsync servers, which transfer and synchronize files across systems, are common. How many more nude photos of patients or ultrasound images will be exposed because of misconfigured Rsync backups?” On May 4, 2017, a group calling themselves TheDarkOverload uploaded almost 180,000 stolen patient/medical records from three companies onto the Internet because (more…)

UnitedHealthCare Denials for ALS-2 Claims

Talking Medicare with Brian S. Werfel, AAA Medicare Consultant Over the past few weeks, we have received emails from ambulance providers across the country reporting that UnitedHealthCare (UHC) has started to deny claims for the ALS-2 base rate. Affected claims include both commercial and Medicare Advantage claims. These providers are reporting that UHC is requiring the use of Current Procedural Terminology (CPT) Codes to support the ALS-2 level of service. When these providers call UHC to question the denials, the customer service representative refers them to UHC’s online policies and procedures manual. The section of that manual devoted to the ALS-2 base rate largely mirrors Medicare’s definition. For example, it indicates that ALS-2 can be billed based on three separate administrations of one or more medications by IV push/bolus or continuous infusion, or upon provision of one or more of the designated ALS-2 procedures (e.g., an endotracheal intubation). However, the manual section then goes on to indicate that “Ambulance Providers or Suppliers are required to report CPT or HCPCS codes… when reporting A0433.  Ambulance transport services that do not include the services described in criteria 1 or 2 above should be reported with a more appropriate ambulance transport code.” The...

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Time to Automate

Founded in 1964, now nationally recognized, Mohawk Ambulance Service is the largest privately owned ambulance service in upstate New York. Our organization services six emergency centers, makes 56,000 trips annually and employs a team of more than 250 staff members. Eighty percent of our trips are for emergency transports where patients are unknown, in critical condition or have no identifying information. Finding fast, efficient ways to verify demographics and discover insurance coverage for these patients is imperative for our revenue cycle and our bottom line. We’ve always worked closely with our local hospitals and nursing homes to obtain information. Many standard processes have been refined over the years with checks and balances to verify coverage, screen deductibles and reduce eligibility-related rejections before claims are submitted to a payor. But our billing team knew we could do more to eliminate duplicate data entry and processing lag time. This article describes our journey to a more streamlined billing process. It includes lessons learned and best-practice recommendations for other EMS providers looking to improve staff efficiency and reduce receivables. First Stop: Real-Time Insurance Discovery The first area we tackled was insurance discovery where we had three employees stationed. We focused on our self-pay...

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