What do you do if you arrive on scene to find a patient who is pale and bordering on delirium in obvious pain? Your training kicks in – all of your senses alert and observing, probing, questioning, prompting and assessing every available vital statistic within moments of clapping eyes on the situation. In mere seconds, you’re moving toward mitigating the pain so that the human body can better cooperate as you begin the process of moving toward stopping its source.
Why, then, do so few EMS companies apply the same scrutiny and urgency to the revenue cycles and operations upon which their businesses depend?
How to Assess the Pain of EMS RCM
EMS operations in pain will always present with lost revenue in the following areas:
- Insufficient level of service at dispatch
- Lack of prior authorizations for non-emergency trips
- Not enough information to justify level of service and/or meet the level of medical necessity
- Only enough information to submit a clean claim before payor deadlines
- Inability to account for payor nuances – billing the right payor at the right time
- Not yet accounting for cost shift to patients with high deductible health plans and related challenges
- Lack of visibility into opportunities and gaps in revenue optimization throughout the cycle (lack of tools to capture and/or present data that is both relevant and timely)
- Paper statements rather than easy, clear ways for patients to provide insurance, make a payment electronically
Where is the EMS revenue cycle pain coming from?
- There is no “back office” in the back of an ambulance.
- Clinicians are responsible for both providing care and gathering billing data, while increased
payor requirements mandate more documentation than ever before.
- Non-emergency transports often involve repetitive patients and discharge scenarios with specific challenges including 1) documentation; 2) audit risk; and 3) customer service.
- High deductible health plans have shifted cost to patients while Medicaid expansion through the ACA has led to a proliferation of brokers and HMOs.
- Claims related to CMS patient trips are scrutinized to identify fraud around medical necessity, resulting in more days in accounts receivables.
Take the time to assess how much pain are you in – feeling OK, are you NOT QUITE SURE, are you in EXTREMIS? Wherever you land on the EMS operational pain scale – it’s time to ask “What are you doing to relieve the pain?”
See how Integra Connect helps EMS operations to stop the pain of revenue cycle management