Printing a bill out on completion of run

[Bieber]

No services around here do anything like this to my knowledge, but it seems like I've heard of it being done somewhere before. I'll have a look and see what I come up with.

Edited May 24, 2012 by Bieber

[Just Plain Ruff]

For those initially opposed and who felt this was a terrible idea, what would you think of the ability to be able to print a bill to those patients who requested a bill.

To not print one out to all patients but just to those who asked at any time during the call what the ambulance run would cost.

the provider could say "I don't know what this will cost but we do have the ability to print you a summary of charges or a bill after I complete my run report. would you like me to do that?"

What do you think of that?

[Bieber]

I don't know, Mike... Maybe it's just because I'm used to the traditional model of billing, but my initial thoughts to such a system are those of apprehension. I don't like mixing business with patient care, and even though I'm not oppose to advising patients about the cost of transport if they don't really need it and it will be a burden to them, I just don't know about the idea of giving patients the bill during patient care.

I'd also think it would be difficult to give most patients an accurate statement when we can't file their insurance on site as well. Isn't the bill patients receive what they owe after insurance?

[island emt]

Let's add in another big question to the equation: How much is your service charging for :

A. BLS calls

B ILS calls

C. Als calls

D No charge for service

Do you charge a flat rate or by the cafeteria menu plan? ie base rate plus so much for O2, IV's Cardiac monitoring, medication administration, mileage etc?

I've seen BLS rates range from $250.00 on up to close to a thousand dollars depending on where in the country you are.

All of these variables would make it hard to give an accurate accounting to a Pt.

Ruff This is a topic that could go in a lot of different directions and have a lot of different potential answers.

[WestMetroMedic]

I think generally speaking, people are insured and they dont have a great functional understanding of how billing works. We as providers generally also know little more about billing than the patient. Its important to recognize why the bill we create is a rather arbitrary number based on actual remuneration from payors or the specific source of remuneration. Patients with private insurance have varying coverage among many other variables. If field providers collect the proper information and obtain their signatures, often times the patient shouldnt even receive a bill, perhaps only an explaination of benefits.

We charge a flat fee at my service plus mileage. We have an easily accessable list of our billing rates and will discuss those charges with patients upon request. I also must be ready to explain why those numbers are crazy high and must account for the costs associated with running an EMS, but must also include the caveat that EMS treatment and transport generally reduces the overall cost of hospital courses enough to justify the expense as evidenced by OPALS. IIRC, our billing charges are apprimately $1100 for BLS, $1250 for ALS1, $1350 for both ALS2 and CPA treat/no trans, and $450 for diabetic treat/no trans plus $23/mile. Our charges are the lowest in our area but not far off.

At the end of the day, we are operating a business and our job depends on revenue. This sucks, but thems the bricks.

Edited May 24, 2012 by WestMetroMedic

[Just Plain Ruff]

True this could go a lot of different directions. I agree.

[Kiwiology]

The charge here is not based upon practice level of the crew

[WestMetroMedic]

BLS, ALS1 and ALS2 are not the crew certification, but rather the medicare billing code. We run strictly dual medic als units but we bill based on the actual level of service we provide. ALS2 is an invasive airway treatment, 3 iv med doses or electrical intervention. BLS is an ambulance ride.

[croaker260]

The charge here is not based upon practice level of the crew

KIwi,

The ALS/BLS is based on the level of the call and evaluation provided, not who who did the call, though if the call is ALS, but you only have a BLS provider, you cant charge above your level. This has been exploited in the past. I k ow of several services that tried to mandate a paramedic in the back on every call to try to bill for an ALS-I billing..... it worked for a while but in the end they got hit...HARD....with penalties. I think one private service CEO was faced with fraud charges. Ironically it was their own employees who turned this in.

There is a somewhat controversial exception to all of this too: Apparently in 911 systems with formal validated EMD systems, if a call comes across as an ALS type response, you can bill at the ALS base even though it may end up as a BLS B.S. call when you get there, the idea is that the complaint warranted an ALS evaluation. I am not sure if this "rule" is still in place, but it was two years ago when we looked at it in my agency. I also know that there were several agencies that took advantage of this too and also got slammed.

Thats the problem with our insurance driven reimbursement model...its 99% based on transport to the most expensive place in health care (The ER), does not allow for alternative destinations, and is so complex that even common sense solutions become mucked up. I am not sure if "performance based" reimbursement would be better than our current "Transport /procedure" based reimbursement, but its pretty stupid as it currently is.

[island emt]

Are the billable' s tied to what the dispatch was for the call ::: or What the EMS providers determine to be wrong & how to treat?

We just had a memo from our dispatch center telling us they were going to start with the apco coding of calls per their EMD software.

That would be fine if they got ALL the info needed to make a determination, & they had eyes on the pt to know if what they are being told is what the pt is actually having as a problem.

Their new system will tell us how to respond Just what I need is a dispatcher in a bunker 65 miles away telling us how to respond. They have a hard enough time figuring out which island we are responding to.