Appropriately managing insurance claim denials and appeal processes for each type of insurance payer is vital for payment.
This blog post is part of a series that addresses ambulance billing best practices. Our ambulance billing blog series highlights tips and insights to help you improve ambulance billing efficiency, lower ambulance claim rejections, and get reimbursed faster.
EMS billers should know how to avoid denials, understand denial and appeal processes for each type of insurance payer, and how to handle ambulance claim resubmission.
Insurance claim denials are part of the EMS billing professional’s world. How big a part is dependent on how well your EMS billing department:
- Understands the ambulance billing denial and appeal processes for each type of insurance payer
- Understands common denial reasons and how to avoid them
- Efficiently handles ambulance claim resubmission
Pay Attention to Payer Specific Rules and Document Them
How you handle an insurance claim denial depends on the specific payer’s guidelines. Some payers prefer spreadsheets, some will handle the resubmission over the phone and some will simply accept resubmission of the same claim.
Your EMS billing software should have a payer setup section that you can use to note a payer specific appeal process, making it easier for EMS billers to keep track of the various rules.
Use the links below to learn more about the different kinds of Medicare appeals.
- Five levels of Medicare appeals: https://www.ehealthmedicare.com/medicare-administration-articles/five-levels-original-medicare-appeals/
- Medicare appeals and grievances: https://www.cms.gov/Medicare/Appeals-and-Grievances/OrgMedFFSAppeals/index.html
Avoid Common Ambulance Billing Denials
Some denials are unavoidable, but many can be avoided with proper EMS billing training and routine quality inspections. Reviewing top denial reasons with your EMS billing staff routinely helps coders stay focused on accurate claim submissions.
Duplicate Claim rejection is a common denial reason that can be easily rectified by verifying the correct date of service and that it wasn’t billed by another agency, such as in a situation of an ALS assist. A duplicate claim denial may also occur if there were 2 transports in one day. When that happens, because of the modifier, there is a likelihood that the claim will be kicked out and maybe not processed.
In these examples, most payers would just ask that you submit additional supporting information on a HCFA form if you had submitted the original claim electronically.
Deal with Ambulance Billing Denials Quickly and Efficiently
EMS billing professionals often make their primary focus getting the ‘claims out the door’ as quickly as possible, which sometimes means posting denials doesn’t get the attention it needs. Set a threshold on how many days out you are willing to put this off. The last thing you want is lost revenue on an easy resubmit because of timely filing.
Avoid Denials & Get Help with Claim Resubmission and Appeal Processes
AIM EMS Billing Services is here to help you avoid denials and handle your ambulance coding and billing challenges. Call us at 1-800-726-4690, fill out our online information request form, or read more about EMS best practices.