Ambulatory - Case Study

Abstract:

Opportunities of generating the revenue from old AR Transportation claims. The transportation services are one of the most important services being provided to all the patients without any verification from the insurance.

The AR > 90 days was $1.6 Million while onboarding this client.

Challenges:

• As we started this recovery AR for EMS billing company, we were provided with 90+ claim aging. Here are the lists of challenges that we had when we started and what we have done to resolve the same.
• Eligibility and Benefits verification:

Verifying the eligibility and the benefits for the patients who needs transportation is a difficult process because the services are provided without any consent.

• No-Transport patients & non-Covered services:

There are patients who might have picked up by another transportation before our service reach the patient’s destination which may cause us without doing transportation

There are services like physician office to residence and vice versa services are not covered by any insurance.

• Auto, WC & VA

This one plays an important role when we talk about challenges in transportation billing because there were most of the cases pending from Auto, WC and VA insurances as the payments are not released on time

• Effective Follow-up

Other challenges that we had while performing this old AR recovery is the effective follow-up is not being done prior to us.

Solutions:

• The above challenges can be resolved by the below steps and by our suggestions from EMS experts.
• Eligibility and Benefits for the patient can be resolved when we verify it as soon as the charges are being entered to the system which can let us know if the patient have an active coverage for transportation, else we should be having a team in-house/patient calling experts if you outsource to make the patient aware that he owes for this transportation as there is no active coverage or benefits.
• The only option to resolve No-Transport and non-Covered services is to bill it to the patient. We should have an effective collection team to ensure certain follow-ups with the patients.
• Most of the transportation claims are involved with injuries as well, so it involves the auto and WC insurance. As we know that the injuries concluded with the court cases, it would take time to get the payment from these insurances. To get the timely payment, we should be contacting the adjuster of the claim in regular interval and also the patient to resolve the case at the earliest time. This is applicable to VA insurance as well but we should be calling the VA insurance claims representative instead of adjuster.
• Following up on the claims effectively with the commercial insurance can get our payments faster. We should avoid the unnecessary appeals, actions taking place which can really stag our money as unrecoverable.