Designate a specialist to troubleshoot EMS claim appeals and spearhead the development of strategies to avoid them.
EMS agencies continue to struggle to make ends meet. The cost of EMS patient care continues to rise, while ambulance reimbursement rates continue to disappoint. In addition, Federal and state regulations continue to multiply. When payers and regulators fail to see the immense value EMS brings to healthcare, economical solutions can be hard to find.
This post, the eighth in a 10-post series, highlights another EMS best practice intended to help your agency keep its footing by increasing efficiency and improving revenue
EMS Best Practice #8: Plan for and Learn from EMS Denials, Rejections, and Appeals
Even with the best EMS processes, best EMS software and the best QA practices, you will still have to deal with some number of denials, rejections, and appeals. How you handle them matters, so take a proactive approach. Designate a specialist to troubleshoot internal appeals and to spearhead the development of strategies to avoid them in the future.
Denial and appeal specialists should cultivate insurance company relationships to resolve issues quickly when they inevitably occur. They should also maintain historical records, so that detailed analysis can be conducted to discover recurring issues and remedies. Reports that display lists of denials, rejections, reasons for denial, and appeal success rate will reveal otherwise hidden trends. Isolate root causes and use this knowledge to improve your billing processes and to improve reimbursement rates.
Want to see all 10 EMS best practices?
Download our eBook, Ten Best Practices to Optimize EMS Workflow, to gain nine more best practices that will help you revitalize your organization, increase efficiency, and improve revenue. It includes concrete actions that you can take to streamline dispatch, simplify patient care reporting, and improve EMS billing to maximize reimbursement.