For ambulance transports, billing starts with the 999 call to capture the reason for the emergency and wraps up with the crew documentation. Between the time from the call to end documentation, the primary role of an EMS crew is to provide patient care.
However, patient care comes in many forms, including both clinical and financial. Financial care is taking steps to ensure proper billing information is gathered during the interaction so that the patient is not financially harmed. In the same sense that crews need to rely on getting information from call intake/dispatch to know where to go and what to expect, billing/reimbursement relies heavily on crew documentation to make appropriate billing decisions and collect the appropriate reimbursement for the patient’s emergent treatment and transport.
In support of improved documentation, there has been an exponential rise in the development of electronic patient care record software. Although many may be hesitant to shift from paper documentation into the electronic space, this new platform for documentation has a sufficient amount of benefits that would certainly pay off in the end.
EMS Billing Before ePCRs
Electronic patient care records, or ePCRs, were far from common when I first started with Intermedix. PCRs were handwritten, hard to read and often incomplete for effective billing and collections. Supply and medication charges were often itemised and sometimes did not match documented narratives and procedures, resulting in potential lost charges. Paper PCRs had to be collected from multiple stations, batched and then mailed. They were often late and not regularly reconciled to call logs, resulting in lost transports. Further, crews were rarely familiar with billing requirements and data collection was thus incomplete for effective and timely billing. Some crews even told patients that they would not be billed for emergency transports, making patient follow-up even more difficult.
Although much has changed and most, if not all, agencies utilise electronic PCRs, medics are still relied upon to collect the information required to meet the changing and increasingly stringent documentation, billing and reimbursement regulations. With this reliance comes a need to provide education to both medics and clients, keeping them abreast about the fluctuating changes that impact each respective group.
EMS Billing After ePCRs
With ePCRs, the percentage of clean claims is much higher than it was with paper reports. Part of the reason for this lies in the expansion of fields available and the secure nature of electronic reports. Using ePCRs, medics can easily input key demographics that assist with proper billing. For example, capturing valuable patient demographics like SSN, DOB and insurance allows billing partners to file claims much quicker and achieve faster reimbursement. With ePCRs, agencies can also enforce close call rules where the medics are required to complete important fields before the PCR is imported into a billing system.
A brief list below highlights these pros and cons for easier evaluation.
Pros of electronic patient care reports:
- Daily receipt of reports with accounts created daily
- Quick claims filing
- Faster cash flow
- Less room for errors in charge capture
- Decreased potential for lost charts
Cons of electronic patient care reports:
- Reliance upon shortcuts may result in inaccuracy or omission
If the ePCR system has shortcut buttons to auto-populate fields, medics may be inclined to use them despite the field requiring a more tailored entry.
Additionally, if the option exists to automatically generate a narrative from selected fields, pertinent details may be omitted and could impact the coding of the run for level of service or medical necessity.
While we can’t ignore the drawbacks, the pros of electronic patient care reports seem to far outweigh the cons. That said, no matter what your agency decides to use for patient care documentation, the bottom line remains the same: good documentation supports both clinical patient care and our ability to help the patient resolve their bill. To that end, it is prudent to find a solution that works for your agency and helps them achieve the ultimate goal of “good” documentation.