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Ambulance Compliance

Perform a prospective or retrospective review of a sample of ambulance claims to evaluate compliance with Medicare regulations governing ambulance reimbursement, Medicaid regulations regarding transportation reimbursement and additional Third Party Payer regulations governing these services on a client requested, Payer-specific basis. Review includes an audit of documentary support for services claimed. Focus is on revenue optimization yet prevention of overpayment. High risk key areas included are:

  • Qualifying Patient Condition(s) and documentary support for such
  • Qualifying vehicle under applicable regulatory definition and documentary support for such
  • Qualifying Staff under applicable regulatory requirements and documentary support for such (including BLS/ALS)
  • Medical Necessity and documentary support for such
  • Audit of compliance with regulations governing "Attended Transport" and documentary support for such
  • Audit of Time Coding, Billing & Documentation
  • Revenue Optimization review of complete and accurate capture of additionally billable, non-bundled services, "POS" Differential reimbursement and appropriate utilization of CCI Critical Care Transport Edits
  • Prevention of overpayment through review to assure complete "Bundling" of services
  • Review of compliance with Certification Requirements and documentary support for such (including "48 Hour Rule")

    • If significant Critical Care Air Transport and/or Neonatal/Pediatric services are provided, reviews will be performed by clinicians and/or coders with expertise in these areas

    If significant Scheduled Transport services are provided, an additional review in this area is available as an add-on or stand alone engagement

    If significant ESRD transport services are provided, an additional review in this area is available as an add-on or stand alone engagement

    While a review of accurate and complete Diagnosis Coding is standard to all reviews, a focused review on diagnosis coding is available as an add-on or stand alone engagement.

    Coding: “per diem” and "backlog" coding services are available by AAPC certified coders

    Our Coding Helpline to answer coding/billing questions on demand is available with a 24 hour response time in most cases.

    “Charge Capture” and “Documentation” Templates

    Physician Practices utilizing Electronic Medical Records and/or Electronic Signatures, compliance reviews in these areas is available as an add-on or stand alone engagement

    A "Shadow Review” service for Third Party Payer "Medical Claim Reviews" is available as an add-on or stand alone engagement.

    Claim Denial, Suspend and Reduction reviews are available to identify problem areas and solutions; including preparing Re-submissions and Appeals.

    Litigation Support in Medicare fraud/abuse actions

    HIPAA compliance reviews.

    Reviews to determine compliance with Medicare's regulations is available as add-on or stand alone engagements

    Stark Law compliance reviews

    Corporate Compliance Plan design, implementation & training; focus is on the OIG's “Model Compliance Plans”

    Seminars in compliance, coding and documentation are available for both clinical & non-clinical staff

    Billing seminars for ambulance/transportation services

    "Update Seminars" are available; focusing on regulatory change

    All seminars are available on videotape.

    Additional services available