The Industry Leader

1. Medicount Management, Inc. 10361 Spartan Dr Cincinnati, OH 45215 1-800-962-1484 The Industry Leader

2. Debbie Fillnow Provider Enrollment • ALS vs. BLS • Medical Necessity Requirements • Billing Methods • National Fee Schedule • National PIN # • Drug Licenses and Certification Medicount Management, Inc. The Industry Leader

3. Determining Level of Service Medicount Management, Inc. The Industry Leader

4. ALS 1 • Transportation by ground ambulance vehicle, medically necessary supplies and services and either an ALS assessment by ALS personnel or the provision of at least one ALS Intervention. • ALS Intervention means a procedure that is beyond the scope of authority of an emergency medical technician-basic (EMT-Basic). Medicount Management, Inc. The Industry Leader

5. ALS 2 • Advanced Life Support 2 Transport- Advanced life support, level 2 (ALS2) is the transportation by ground ambulance vehicle and the provision of medically necessary supplies and services including (1) at least three separate administrations of one or more medications by intravenous push/bolus or by continuous infusion (excluding crystalloid fluids) or (2) ground ambulance transport and the provision of at least one of the ALS2 procedures listed below. 1. Manual defibrillation/cardioversion2. Endotracheal intubation3. Central venous line4. Cardiac pacing5. Chest decompression6. Surgical airway7. Intraosseous line Medicount Management, Inc. The Industry Leader

6. Determining Level of Service Medicount Management, Inc. The Industry Leader

7. Determining Level of Service Is Ox Is Oxygen considered a Drug for the Purpose of Determining ALS II level of service? No, Oxygen is not considered a Drug. Is Aspirin considered a Drug for the Purpose of Determining ALS II level of service? No Dispatched to scene of accident. Loaded patient and transported patient roughly 1 mile to site of helicopter for life flight to trauma hospital. My understanding would be to have the ground ambulance bill their level of care provided to the insurance company with a modifier of (S) scene to (I) Intercept. Yes. The ambulance supplier transporting the beneficiary would bill Medicare for the level of service provided and mileage from the scene of the accident to the point of transfer to the air ambulance. Medicare covers the transport of the beneficiary and the medically necessary services provided to the beneficiary. Medicount Management, Inc. The Industry Leader

8. Medical Necessity Medicount Management, Inc. The Industry Leader

9. Methods of Billing Medicount Management, Inc. The Industry Leader

10. Nation Fee Schedule Medicount Management, Inc. The Industry Leader

11. National Fee Schedule Medicount Management, Inc. The Industry Leader

12. Implication of Fee Schedule Medicount Management, Inc. The Industry Leader

13. National Provider Identifier • The Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandated that the Secretary of Health and Human Services adopt a standard unique health identifier for health care providers. On January 23, 2004, the Secretary published a Final Rule that adopted the National Provider Identifier (NPI) as this identifier.  • All HIPAA covered healthcare providers, whether they are individuals or organizations, must obtain an NPI for use to identify themselves in HIPAA standard transactions. Once enumerated, a provider's NPI will not change. The NPI remains with the provider regardless of job or location changes. • HIPAA covered entities such as providers completing electronic transactions, healthcare clearinghouses, and large health plans, must use only the NPI to identify covered healthcare providers in standard transactions by May 23, 2007. Medicount Management, Inc. The Industry Leader

14. Drug License and Annual Certification Medicount Management, Inc. The Industry Leader

15. EMS Claim Processing • Dept. Summary • Electronic Uploads • Documentation • Resident vs. Non Resident • Face Sheets • RTML and Skip Tracing • Mutual Aid Billing • Reasons for Denials • PDPR/ PDPT • Discount Requests Medicount Management, Inc. The Industry Leader

16. Data Entry Status Claims Patient Relations Payments Billing Departments Medicount Management, Inc. The Industry Leader

17. Electronic vs. Paper uploads • Stone age or Computer Age? • How to transmit your data to State, TPA……. • Face Sheets! Medicount Management, Inc. The Industry Leader

18. Soft billing is a common misconception, it is not Insurance only billing • Residents • Insurance Billing only • No out of pocket expense • No insurance, No Fee • Non-Residents • Insurance Billing • Soft Billing approach all co-payments • Soft Billing for those uninsured Medicount Management, Inc. The Industry Leader

19. Proper Documentation • Resident Designation • Proper spelling of patient name and address. • Correct date of birth and social security number. • Patient insurance information (Face Sheets) • Patient phone number Medicount Management, Inc. The Industry Leader

20. Patient Assessment • What is the patients chief complaint? • Descriptive narrative and patient notes • Documenting patients vitals • What services were administered to the patient • The rank of the EMS crew Medicount Management, Inc. The Industry Leader

21. Implication of Billings • Financial Hardship- Financial considerations will be offered for all those patients without the wherewithal to satisfy any balance • Hospital requests- There will be no change in your current protocol when specific hospitals are requested. • Visitors of Residents- If the guest of your resident requires a transport and does not reside inside the district, the patient is to be considered a non-resident. Medicount Management, Inc. The Industry Leader

22. _________ are like gold. + + Medicount Management, Inc. The Industry Leader

23. Return Mail and Skip Tracing • NCOALink48 NCOA. The National Change of Address database holds over 152 million moves, archived for the past 48 months. Especially for healthcare applications where you may see a patient only every year or so, it is far superior to FastForward, which archives for only the past eighteen months. The proper use of NCOA allows us to eliminate approximately 85% of would-be return mail. • AEC. After sending your addresses through NCOA, any address that does not receive a Delivery Point Barcode, is sent back to the USPS for Address Element Correction – AEC. AEC corrects misspellings, missing directionals (S,N, SW, etc), missing suffixes (ST, DR, AV) etc. This service enables us to get Delivery Point Barcodes for over 65% of the 15% that was rejected by NCOA. The result to you is dramatically reduced return mail. • Selective Suppressions. We suppress that piece of mail from printing and send you a report of all such suppressions. The most common reasons for address suppressions are “Moved, Left No Forwarding Address” and “Undeliverable as Addressed”. More than 50% of the mail that is undeliverable at this point is because an apartment number or suite number was missing. Medicount Management, Inc. The Industry Leader

24. Mutual Aid Billing • Only ONE ambulance supplier can submit a claim for the service. • The involved suppliers must determine who will submit the claim and how the reimbursement will be distributed. • When a patient is transferred from a BLS vehicle to an ALS vehicle, the ALS service may be allowed. • When ALS personnel and equipment are placed onboard a BLS vehicle, the BLS vehicle is qualified as ALS and an ALS service is allowed. • When a BLS vehicle transports a Medicare beneficiary to a rendezvous with an ALS vehicle, and ALS personnel and equipment join the patient in the BLS vehicle, the trip is allowed as an ALS service. Medicount Management, Inc. The Industry Leader

25. Reasons for Denials • The Medicare ambulance benefit is a transportation benefit only. Without a transport there is no payable service. • When multiple ground ambulance providers respond, payment will be made only to the ambulance supplier that actually furnishes the transport to the destination. (If Mutual Aid is involved, refer to that section.) • Ambulance suppliers that arrive on the scene but do not furnish a transport are not due payment from Medicare. (Exception: See Death of Beneficiary Section.) • No payment will be made for the transport of ambulance staff or other personnel when the beneficiary is not onboard the ambulance. Example: an ambulance transport to pick up a specialty care unit from one hospital to provide services to a beneficiary at another hospital. • Ambulance transport is NOT covered when other means of transportation could be utilized, without endangering the patient’s health. • When submitted documentation does not support the medical necessity. • Codes submitted that are not listed in this article. • When the use of ambulance services was unreasonable because the treatment of the illness or injury could be provided without requiring the beneficiary to be transported to a covered destination. • Medicare will not pay for an ambulance service when an ambulance was used for convenience or because other means of transportation were not available. • Ambulance service will be denied when the patient is generally mobile and able to safety walk or move to the vehicle with or without assistance including the use of a cane, crutches, walker or wheelchair. Medicount Management, Inc. The Industry Leader

26. Insurance Paid Patient Analyze total revenue distributed and lost to patients vs. total reduction in revenue from accepting assignment Insurance Paid Provider Ensure that all members of the staff that have access to incoming mail knows to forward EOB’s to TPA. Lost Checks… Lost Revenue Medicount Management, Inc. The Industry Leader

27. Discount Requests • Multiplan, Concentra, ….. • Ask them “Why should I accept your offer?” • Many times the only answer is a faster turn around for a 30% discount. Medicount Management, Inc. The Industry Leader

28. Quality Control • Client Logs • Charge Report • Credit Report • Adjustment Report • 12 month charge/credit analysis • Quality control auditing • SAS 70 audit • Dan Owens, Von Lehman & co. Medicount Management, Inc. The Industry Leader

29. Client Log, Account Summary Medicount Management, Inc. The Industry Leader

30. Detailed Charge Report Medicount Management, Inc. The Industry Leader

31. Detail Credit Report Medicount Management, Inc. The Industry Leader

32. Detailed Adjustment Report Medicount Management, Inc. The Industry Leader

33. 12 Month Charge/Credit Analysis Medicount Management, Inc. The Industry Leader

34. Level 2 SAS 70 Audit • Dan Owens • Von Lehman & Co. Medicount Management, Inc. The Industry Leader