Omni EMS Billing’s Grant Helferich and KEMSA lobbyist rep Jason White will be meeting with Senator Kelly in Topeka, KS next week. Objectives of the meeting include discussing Kansas EMS’s
- high rate of denials
- delays in reimbursement
- low Medicaid reimbursement rates
- FRA/CPE/GEMT program issues.
Everyone knows that good documentation should be a priority for EMS administrators, manager, and staff. But what should be done when performance doesn’t quite meet the standard?
The first plan of attack should be to handle the mistake with integrity. Own up to your mistakes and acknowledge them. Do not, for example, write that the “patient was unable to sign” on the signature line simply because you forgot to collect the appropriate signature or didn’t have the time.
Secondly, be proactive and confirm that a documentation policy is in place at your EMS department. An up-to-date documentation policy is imperative when considering the protection of a service’s employees, integrity, legality, and income. In the Medicare and Medicaid world, an action not documented is an action not taken. Recreating the events after they have taken place is a luxury you may not get or have the memory capacity to recall. Nobody wants to find themselves on a witness stand without a quality patient care report.
For this reason and others, EMS departments should establish a documentation policy stressing the importance of truthfulness and thoroughness. The policy should also contain guidance on legibility of all documents, what information should be included in the report, the amount of information contained within the report, and direction in obtaining appropriate signatures. This policy will guide staff in creating quality documentation- improving patient care, eliminating grounds of legal questioning, and increasing the chance of payment justification.
Documentation may not be the most exciting task in one’s day, but it may very well be the most important. Putting the time and diligence in creating quality documentation will be worth it, guaranteed.
Contact Omni EMS Billing if interested in participating in a documentation webinar lead by EMS billing expert, Grant Helferich.
by Grant Helferich
As turn the page on 2015, we can look back and reflect on what a year it has been. One of the biggest hurdles faced by EMS providers in 2015 was the planning, educating, training and implementing of ICD-10 coding. If EMS agencies did not budget and take the time to plan, attend education programs or provide training to their EMS staff, their budget may be severely impacted by an increasing number of denials or post payment audits by the insurance industry
Omni EMS billing spent over 100 hours working with their staff in all areas of the implementation process. They offer free training webinars to assist clients in equipping their staff to respond correctly with ICD-10 challenges.
The insurance industry has indicated that the rollout for ICD-10 has gone smoothly for most of the large health insurance providers.
However, this may not be true for everyone. Some EMS agencies have seen an increase in denials. This may be due to poor documentation in the support of medical necessity and the medical interventions that were provided to the patient. (click here to read more about Medical Necessity).
To reduce the risk of denials or audits by the insurance industry, EMS managers must do an internal assessment to determine all areas of their agency affected by the ICD-10 transition. This will help in creating an effective gap analysis. A gap analysis is a tool used to evaluate the difference in potential performance as compared to actual performance. It includes strengths, weaknesses, opportunities, and threats.
This gap analysis tool can be used to improve many aspects of your company’s operations such as data collection and documentation policies; system software; healthcare information compliance; education and training needs; and quality assurance / quality improvement process.
One of the most transformative ways a gap analysis can be of use, is through the analysis of your medical documentation policy process. The gap analysis of the policies and procedures for the patient care report completion should include the following key points:
- obtaining appropriate signatures
- detailed reporting to support medical necessity and
- a full detailed assessment on each patient
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