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Presented by Matthew Smith.  Headquartered in Englewood, CO  Established in 1980  306 Bases  More than 4,000 employees  Currently operate in 47 states.

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Presentation on theme: "Presented by Matthew Smith.  Headquartered in Englewood, CO  Established in 1980  306 Bases  More than 4,000 employees  Currently operate in 47 states."— Presentation transcript:

1 Presented by Matthew Smith

2  Headquartered in Englewood, CO  Established in 1980  306 Bases  More than 4,000 employees  Currently operate in 47 states  Patient Business Services office located in San Bernardino, CA  Employ 100 employees in our billing department  Billing Service – Complete Billing Solutions  Publicly Traded NASDAQ: AIRM

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4  All Billing Staff goes through a new hiring training program to include:  HIPAA training  HITECH Training  Red Flags Training  Sexual Harassment  Violence in the Workplace

5  Productive Work Environment  RNB Training  Medicare/Medicaid Training  Ambulance Billing Training  Review performance standards and expectations  Review Policies and Procedures

6  Policies and Procedures  Have written policies and procedures  Update policies and procedures regularly  Policies and Procedures should be readily accessible to your team  Reviewed annually and employees are required to sign an acknowledgement that they have read and understood the policies

7  The signed acknowledgement becomes part of their personnel file  Employees are required take post training tests and demonstrate that they understand the material covered

8  Employ a full time Standards and Compliance Auditor who performs a variety of audits throughout the year  Internal Audit Department conducts multiple audits throughout the year

9  Air Methods hires an independent claims review consultant to perform annual audits to ensure compliance with Federal and State regulations, and provide any recommendations or feedback for any areas that may need improvement

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11  A weekly KPI is produced and provided to our top levels of leadership to monitor and track the performance of the billing department  A/R Aging by financial class  Denial Tracking (Expected vs. preventable)  Number of Claims Billed by Financial Class  Number of Flights on Hold and the $ value  Cash Collection vs. Cash Goal  Collection Agency Assignments vs. Recoveries  Transport to staff ratio

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13  Unbilled Report  This reports captures any accounts in the system that have not been billed in over 4 days.  Distributed to the leadership team every Monday ▪ Distributed by financial class

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15  Stagnant Account Report  Report that captures any account that has not had any follow up action in over 30 days  Automated report that goes to the leadership team every week  Includes the last note and the last note date on the account to allow for quick and easy spot checking of accounts

16  A weekly report is produced that is shared with our bases of any missing documentation that is either stopping or causing a delay to the submission of claims  Report is sent to all local and regional management, to include the names of the individuals that are delaying the billing process

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18  Monitor Employee Performance  Each employee has a daily production standard  User Activity Reports and Phone Activity Reports  Supervisor gets a summary of all activity for the previous day, to include the time of each entry in the system, and what notes were entered on each account to allow for quick and easy spot checking  Department Supervisors perform Supervisor Spot Checks on each employee every month, and provide feedback to each employee

19 Insurance Department (Collectors) - User Activity Report For The Period 4/26/2012 To 4/26/2012 UserChange DateChange TimeTrip DateRun #Last Note TypeHistory Entry Team Member A Total Changes For:Trips TouchedHistory Entries% of Total% of Daily Goal Team Member A %94.0% (50 accounts per day) Team Member A Total Changes For:Trips TouchedHistory Entries% of Total% of Daily Goal Team Member A %94.0% (50 accounts per day) Team Member A Total Changes For:Trips TouchedHistory Entries% of Total% of Daily Goal Team Member A %106.0% (50 accounts per day) Team Member A Total Changes For:Trips TouchedHistory Entries% of Total% of Daily Goal Team Member A %108.0% (50 accounts per day) Team Member A Total Changes For:Trips TouchedHistory Entries% of Total% of Daily Goal Team Member A %60.0% (50 accounts per day)

20 :44: Insurance Collection CallCalled BCBS of FL (blue , spoke to Erica and explained that the appeal was mailed on 04/19/12; need to verify that the appeal was received and sent for review. She states the appeal was received on 04/24/12 and she is forwarding the a :44: Insurance Collection CallChanged Call Back Date from 04/26/2012 to 05/10/ :44: Insurance Collection CallChanged Next Event Date from 06/01/2012 to 06/10/ :44: Insurance Collection CallAdded Note: Insurance Collection Call - Per the USPS.com website the certified letter was delivered on 04/24/ :44: Insurance Collection CallCalled BCBS of FL (blue , spoke to Erica and explained that the appeal was mailed on 04/19/12; need to verify that the appeal was received and sent for review. She states the appeal was received on 04/24/12 and she is forwarding the a :45: Insurance Collection CallChanged Call Back Date from 04/26/2012 to 05/10/ :45: Insurance Collection CallChanged Next Event Date from 06/01/2012 to 06/10/2012

21 Talk/Down Time By Extension 4/18/2012 ExtensionTalk TimeInternal TimeDown TimeDown Time % Insurance Collector 16:03:360:02:181:24: % Insurance Collector 25:54:300:04:001:31: % Insurance Collector 31:21:420:03:546:04: % Insurance Collector 41:14:540:00:006:15: % Insurance Collector 54:10:120:00:003:19:4844.4% Insurance Collector 64:58:240:03:002:28: % Insurance Collector 74:22:360:00:303:06: % Insurance Collector 86:42:360:00:000:47: % Insurance Collector 96:09:420:03:181:17: % Insurance Collector 104:36:300:00:002:53: % Total Talk Time:45:34:420:17:0029:08:18 Percentage Total:60.77%0.38%38.85%

22  Open Accounts  We monitor the number of open accounts in each financial class to help us to manage the A/R and ensure that accounts are worked timely and appropriately

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24  Weekly and monthly reconciliation of all ambulance trips to ensure timely billing / collections and identify any potential problems quickly  Reconcile our A/R posting to our bank deposits on a daily basis

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26  All Billing Activities are documented within the RescueNet Billing System  Each team member has a monthly review to evaluate their performance and address any performance issues, and recognize those team members who are meeting and/or exceeding our expectations

27  Extensive QA process that each biller must follow when submitting claims to the various payers  Patient Demographics  Insurance Eligibility  Completion of required forms  Medical Necessity Properly Documented, HCPCS, Modifiers, Charges, etc  Claims reviewed by multiple departments

28  File as many claims electronically as we can  Medicare  Medicaid  Commercial Insurance Carriers  Government Payers

29  Schedules and events are modified to mirror the payers payment cycle  Schedules are designed for unique situations ▪ Payment sent to insured ▪ Shorter / Longer Expected Payment Cycles ▪ Specific Documents Needed  Schedules and events are closely monitored to ensure timely follow up activities

30  Move towards paperless operation:  Electronic Claims Filing  EFTs  ERAs  Online Claim Status  Online Claims Appeals

31  Medicare Advantage Plans  Matrix of all Medicare advantage plans is kept up to date as to which plans accept fractional mileage, and which ones do not.  Medicare advantage plans that do not accept fractional mileage are rounded up to the next whole mile.

32  Utilize Vendor to verify insurance eligibility  We send automated batches of all private pay accounts to a third party vendor to search for Medicare, Medicaid, and the top 5 commercial insurance companies for the geographic region that the patient resides in

33  Each Insurance Collections specialist has been provided with the Prompt Pay Laws for each of the states, which are cited in their collection calls and the collection letters that we send to insurance companies  If the payer fails to pay claims in accordance to the prompt pay laws, we demand interest as outlined in the prompt pay laws  Persistent with the insurance companies

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35  All denied/underpaid claims are reviewed for appropriateness, and all claims inappropriately denied are appealed to the highest level  Standardized “skeleton” of appeal letters to address the most common denials

36  Incentive Programs  Exceeding production goals  Positive Customer Feedback  Attendance  Individual and departmental collections  Meeting A/R and DSO goals  Years of Service  Suggestion Box  Exceeding our expectations

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