Consistent cash flow is essential to the operation of EMS organizations, but from the moment each call begins, there鈥檚 a lot that can get in the way.
Patients may be unable to provide their own demographic and insurance information, forcing EMS providers to track it down later, before they can seek reimbursement. Furthermore, patients might not know their insurance coverage or be carrying a current card. Even with a patient name, supporting details like address and phone number may remain unknown. Without complete, accurate insurance information, agencies may end up billing the wrong payer or billing patients directly for services that were actually covered.
It can all add up to revenue cycle management (RCM) processes that are slow and manual, delays in claim processing, and ultimately, missed opportunities for reimbursement 鈥� not the outcome any organization wants to see.
鈥淲hen these kinds of issues occur, a claim that would normally move through the system in several days could take weeks before a payment to be issued,鈥� said Stacey Bickford, senior product manager at . 鈥淭hese are the kinds of situations we try to prevent users from encountering.鈥�
Central to that goal for ZOLL Data Systems 鈥� a leading provider of health care software and data solutions that help improve clinical, operational and financial outcomes for EMS, fire and health care organizations 鈥� are cost-effective, easy-to-use software and innovative services for billing and revenue cycle management that can help increase staff accuracy and efficiency and reduce their administrative burdens without requiring costly infrastructure and specialized IT support.
AUTOMATION AND FLEXIBILITY POWER BILLING SOFTWARE
is a cloud-based EMS software solution that helps revenue cycle professionals simplify and expedite their billing, streamline their workflows and ultimately, bring home more dollars.
Even beyond the pitfalls inherent in collecting patients鈥� personal and insurance information, the billing process can pose additional challenges. Documentation and coding can have inaccuracies, payers may have particular requirements, and the manual processes of preparing and batching claims can be prone to errors. ZOLL Billing improves the process with automated workflows and numerous time-saving features that advance the process and help avert mistakes.
One example involves reimbursement amounts determined by the Medicare fee schedule. Rather than requiring billers to enter those numbers manually, ZOLL Billing populates them automatically, ensuring accuracy and enhancing speed.
鈥淢edicare requirements and fee schedules are built into the software and updated annually so customers can be confident they鈥檙e getting paid based on the current information,鈥� said Bickford. 鈥淗owever, they also have the ability to build in their own fee schedules. It is the perfect merger of automation and flexible configuration.鈥�
鈥淚t鈥檚 a fully integrated billing and RCM optimization solution,鈥� added Kristin Whitt, director of operations at . 鈥淥ther built-in tools can verify patient demographics, discover hidden coverage for self-pay patients, determine eligibility and help agencies partner with patients to improve collections on self-pay balances. Claims are routed properly, and billing lag is kept to a minimum.鈥�
The insurance discovery tool is another key advantage. 鈥淚t helps our customers actually verify that the insurance information they received is valid and active for the date of service,鈥� Bickford explained. 鈥淎t the same time, the demographic verifier tool helps our customers fill any gaps in patient data. The self-pay analyzer tool helps determine a patient鈥檚 likelihood to pay so agencies can help drive their back-end claims and collections workflow.鈥�
Additional attributes of ZOLL Billing include support of 鈥渞ight-day鈥� billing through automated monitoring of deductibles; real-time tracking of cash flow; accurate predictions of claim reimbursement amounts and timing; and analytics that can help organizations get their payments faster, with less administrative scrambling.
CLAIMS CLARITY SERVICE DELIVERS NEGOTIATING POWER
What kinds of reimbursements should you be getting? What are other EMS agencies receiving for similar services in your area? Do your payer agreements measure up? It can be hard to know with antitrust and collusion rules in place and payers disclosing as little information as possible.
The ZOLL data service delivers health care market intelligence to improve reimbursement transparency and help organizations negotiate the best payment rates possible. Specifically, the data service can help users avert surprise billing disputes, inform payer contract negotiations and power smart business decisions. Users can access key data such as payers鈥� qualifying payment amounts (excluding 鈥済host rates鈥�) and median in-network rates. These features reduce the risks involved in pricing new models and services, allow more informed evaluation of commercial impacts and provide both visibility into what area competitors are charging and a greater ability to forecast reimbursement revenue.
Powered by actual, de-identified claims data, the ZOLL Claims Clarity service elicits the numbers behind payer calculations and helps agencies establish competitive rates. Users can see and compare actual reimbursements from payers within their region and service area in compliance with rules and regulations.
鈥淲hen you鈥檙e getting data from payers, you always have to question what they 补谤别苍鈥檛 including,鈥� explained Bickford. 鈥淥ur data is actually from adjudicated claims from clearinghouses, so that鈥檚 a big differentiator. We also have average paid amounts because of that, in addition to the average allowables and charges.鈥�
All this empowers agencies to dig into their specific specialties by procedure codes in their geographical region and see what payers are doing. For example, if they live in Dayton, Ohio, they can see the average reimbursement for an ambulance trip in Dayton for the top payers and how their own fees measure up.
鈥淭his puts the negotiating power in the agency鈥檚 hands,鈥� said Bickford.
CLEAR SKIES IN THE CLOUD
Both these products are cloud-based, so customers and their IT teams can relax. Data is securely backed up, updates are automatic, and users can work 24/7 from any connected device. When customers do have a question, they can get quick feedback and help from the support team.
鈥淲e host the software and data services, so customers just have to log into their web-based applications. They don鈥檛 have to maintain servers, and they don鈥檛 need an IT infrastructure for it,鈥� said Whitt.
That ensures operations on the back end that are as smooth and simple as they are on the front 鈥� with thorough approaches that help overcome the many pain points to which EMS billing is vulnerable and get more reimbursement in hand faster.
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