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Is Jacking Billing Rates Common?
A fire department is accused by a former employee of taking minor ambulance calls and billing to a higher rate for a more serious call.
City has to settle with the Feds.
Whistle-blower get 1.35 million dollars for his efforts.
My question is: is billing at a higher rate common or is this an isolated incident?
Read the story here:
http://qctimes.com/news/local/article_2f0360ba-dd8f-11df-90e1-001cc...
Replies to This Discussion
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Permalink Reply by big o on
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funny we had a billing discussion as part of our training last night, talking to the chief about it he said the only time we would bill is there is insurance involved and we would never bill the patient directly meaning insurance only and to make sure that we crossed all our t's and dotted the i's on the run reports for what we used because the insurance companies would pick it apart and if we didn't use or couldn't prove we used it we most likely wouldn't get paid at all for the run
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Permalink Reply by John Crabbe on
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Common? I don't think so. The question does become what is considered higher rate, or what makes the determination.
Is starting an IV, really considered ALS if it is part of EMT-Basic IV skills?
Is doing a 12 lead, once a paramedic skill, now an EMT-B skill, considered ALS?
That would be the stuff the dept may use in making the determination as to what is considered the difference between ALS and a BLS call. It could be argued that an IV was established because of a "just in case" or depending on protocol, that that skill makes the call ALS....and thus subject to a higher bill rate. So it can be a fine line as to what determines what the rate will be, but I don't think billing minor calls at a higher rate is a common occurance.
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Permalink Reply by Brad Harvey on
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Oren, you should check your plan out with someone who know a bit about EMS billing. The rule used to be that if you planned on billing Medicare/Medicaid at all, then you had to bill everyone. You legally could not selectively bill people. Now, whether or not you took enforcement action was another story but you had to keep records as to what attempts were made to collect and audits of those records were always possible. It may be different now but the last I was involved with billing was only a few years ago. You should definitely check. I don't want to see your department become a headline! :-)
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Permalink Reply by David Reeves on
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Why have EMS provider make the decision on ALS vs BLS? This is the reason Depatments get in trouble and are paying huge fines, let your Third Party Billing Company made that decision.
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Up Charging while not common, is a very serious problem for EMS Providers. That is why when choosing a Third Party Billing Company is very important. The Billing Company I am with, Medicount Management, will determine at what level Ambulance charges should be billed.
As far as who gets charged what there are several different ways your billing can be set up, no bills for residents and only bill the insurance company and bill non-residents for the balances. The balances for residents can then be written off or write off everyone's balances. Bill everyone for balances or write off everyone's balances. We have solutions for every Departments Billing needs
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Up Charging while not common, is a very serious problem for EMS Providers. That is why when choosing a Third Party Billing Company is very important. The Billing Company I am with, Medicount Management, will determine at what level Ambulance charges should be billed.
As far as who gets charged what there are several different ways your billing can be set up, no bills for residents and only bill the insurance company and bill non-residents for the balances. The balances for residents can then be written off or write off everyone's balances. Bill everyone for balances or write off everyone's balances. We have solutions for every Departments Billing needs
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sorry brad i guess i should have been more specific we don't bill for ems because we are non transport i was talking about the fire and mva side of things is were we do our billing, the local ambulance bills all the ems calls we just take what we used off the trucks let them know what we we used and then they bill for it sorry I wasn't more specific n my post
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