The Whys and the Whats of Documentation

Successful, compliant billing for ambulance services requires a strong process for obtaining and interpreting documentation. Documentation is a broad term that encompasses many different requirements for coverage including clinical details, transport details, medical necessity, reasonableness, forms, and signatures. Each of these requirements are important, and we will discuss them in future posts, but for now let’s focus on the process. From your crews, to QA, to your billing staff, everyone who touches your documentation and their ability to follow your process will impact your service’s bottom line. That’s why we focus on teaching our clients the Whys and the Whats of compliant documentation. The Whys refer to Medicare and other regulations that make up the criteria for a covered (payable) ambulance transport. The Whats refer to all the procedures for documenting and billing an ambulance transport that ensure a trip meets the coverage requirements. We’ve found many services struggle with maintaining a cohesive process that ensures everyone understands the Whys and the Whats. Ask yourself, do any of these situations sound familiar?

  1. Your crew receives a call from a facility or the patient’s residence for an emergency. However, once they arrive on scene, the patient’s condition doesn’t appear emergent and/or is different than the condition that was described at dispatch and the crew starts to become skeptical about the validity of the transport.
  2. Your crews are motivated and engaged by the catastrophic accident and disaster transports but are often jaded by the monotonous non-emergency transports and begin to insert their personal opinion into their evaluation of the patient and/or produce documentation that lacks the same attention to detail that the “exciting” transports have.
  3. Your QA team finds itself with a backlog of transports that lack detail or are missing information and they feel stuck between (a) having to send everything back to the crews, putting a strain on their communication, or (b) pick and choose their battles, focusing on the “big” issues while hoping the “little” issues pass under the radar.
  4. Your billing staff finds itself having to do work that they feel QA should have caught and feels pressure to either bill a claim as it is or send it all the way back to the crew for more information.
  5. Supporting documentation or signatures are incorrect or not attached to the transport documentation and the billing staff finds itself days or even a week behind obtaining the documents or signatures.

If any of these issues sound familiar, it’s because your process isn’t working as well as it could, and your different groups of employees aren’t speaking the same language. When your employees aren’t speaking the same language of compliant documentation, they can’t communicate and understand what the other groups need, which can lead to avoidable errors in billing.

We believe that when everyone in your organization understands the Whys and the Whats of compliant documentation— and can see where their job is affected—the problems in your organization’s billing process will stop compounding on themselves, your employees’ jobs will become easier, and your organization will be more compliant.

We’re offering a detailed training program for your employees that will help them all understand and find their role in the Whys and the Whats of compliant documentation. Get in touch with us today to request a demo or more information about our interactive online training program and let us help you develop a unified process for complaint billing.