Flatworld Solutions has over 20 years of experience in emergency medical solutions. Over the years we have dealt with all the unique challenges faced by emergency medicine groups and therefore have a fair understanding of all that which needs to be done to overcome these challenges. The primary two challenges understanding the priorities and coding and billing accordingly.
As an experienced emergency medicine billing services company, we work with your group, as an extension of your business and help you focus on the core aspects of your business. Our billing process is designed to be accurate enough to ensure there is no denial of claims. We guarantee this with the help of a due procedure which involves seeking prior authorization, followed by accurate coding and due quality checks, to ensure you get fully paid.
What is Emergency Medicine Services (EMS)?
Emergency medicine services are services that aim to treat injuries and illnesses that require urgent medical response. It consists of providing either out-of-hospital treatment or in-hospital treatment primarily at the emergency department. It also involves services rendered in the form of transport to definitive care. The goal is to address an urgent medical care or arrange for a timely removal of the patient to the nearest definitive care.
We team up with you to provide the best emergency medicine billing services. We strive to form strong partnership with you. We incorporate complete transparency with communications and information so that all major billing burdens stand removed for your practice. We have worked with numerous clinics and hospitals client to provide timely and correct emergency billing services.
Why is EMS Billing Services So Tough?
Emergency medicine billing services is quite unlike other forms of medical billing. This is because it is not based on a definitive diagnosis. The need is to treat a patient on their apparent condition which makes certain aspects of the billing very difficult. It relies heavily on the patient care report prepared when the patient is picked up from the place where the need arises. Other aspects that make emergency medicine billing difficult are -
- The report must reflect all specific details of the patient's condition and must have the specific terminology such as service provided for Basic Life Support (BLS), Mileage documentation, Advanced Life Support (ALS) etc. A slight error in any of these facts impacts the coding for the billing process leading to denials.
- The inclusion of beneficiary signature rules on behalf of the patient consists of a set of complex issues that need to be done correctly, else chances of denials by Medicare, the single largest payor of emergency bills, are always high.
- Though most of the coding part of emergency billing service is related to the body, it also comes with several modifiers such as place of origin and destination of the ambulance trip. Wrong use of modifiers can cause the processing time to be hit.
- Before submitting the bill for claims verification of the information is necessary to properly bill the claim. Only properly verified information can be turned into a payable claim.
- It is important to understand the criteria that determines "medical necessity" in order to determine the proper level to bill. This criterion must also include the various levels of ground and air ambulance services used for rendering the emergency service.
- Rules pertaining to emergency billing keep changing very fast and it's important to be on top of it to prevent denials.
- There is a strict need to adhere to HIPAA compliance related to Security, Privacy and Compliancy laws else the provider may inadvertently walk into the "fraudulent" category.
- Many insurance plans do entertain contracting ER doctors. They pay whatever benefits as per a pre-determined emergency classification.
- Commercial insurances have an undeclared policy of reducing their reimbursement for emergency medicine billing. Likewise, they increase patient liability for emergency cases by using third party pricing companies.
- Insurers always prefer to settle emergency medicine bills for out of network hospitals at in network rates to save as much money as possible.
- Some insurers prefer to pay the claims to directly to the patient forcing hospitals to turn to their patients for payment recovery.
- Some insurers automatically adjudicate emergency medicine claims based on an applicable ED claim category which again differs from payor to payor. If the code classification falls into lower level of complexity which it often does, then the reimbursements would be lower.
- Our understanding of all the nuances of emergency medicine billing services makes sure that the reimbursement for hospitals and physicians is always optimum.
All these together make emergency Medicine billing very challenging and only an experienced service partner can help you get full reimbursement from insurance companies.
Emergency Medicine Billing Services We Offer
We provide a host of emergency billing medicine services. These include -
Emergency Medicine Billing Documentation
Our emergency medicine documentation process helps you classify and annotate texts and scans followed by proper indexing and storing. We scan, upload and store the documented files.
Emergency Medicine Billing Coding Consisting of Payer Specific Coding
With this service we ensure payor specific code is assigned to every treatment and procedure carried out. We get it done through coders who specialize in coding for the payor.
Emergency Medicine Backlog Coding Resolution Services
With this service we provide coder reinforcements to help hospitals deal with emergency medicine billing coder shortage. Our coders work 24/7 alongside your coders to ensure all coding backlogs are completed and reviewed on time.
Emergency Medicine Coding Audits
Our emergency medicine coding audits are designed to help you overcome errors in the coding process. Our clients send us the billing documents and our emergency billing experts run a second eye over it spot errors and inconsistencies.
Emergency Medicine Billing Reporting
with this service we keep hospitals updated on the account's status with the respect to their emergency departments. The various reports we provide include accounts receivables aging reports, payment trend and collections from the emergency department, patient payment reports, clearing house rejection reports etc.
Compliance Reviews for Emergency Medicine Billing
With this service we help ensure all emergency billing documents and coding are harmonized with HIPAA and OIG requirements as well as the heath care reforms act.
Emergency Medicine Billing Process We Follow
01. Transmission of Claims
After the hospital or clinic receives an emergency patient and completes initial reporting's of the patient's condition it forwards all information pertaining to the patient to our billing team. These docs include, charge-sheets, insurance verification data and other patient information. The docs are submitted to us as scanned copies through a secure FTP server.
02. Information Retrieval Followed by Doc Checking
After we are informed by the hospital, our staff will retrieve the information from the FTP server and carry out a meticulous checking for any missing information in the documents. If the information is illegible or inconsistent, our team gets in touch with the emergency department of the hospital or healthcare facility and seeks the docs anew.
03. Medical Coding
After all the corrected docs are obtained, our coding team takes over to code for the treatment and procedures. In this stage our coders affix the right codes for the diagnoses and procedures based on ICD-10 (International classification of Diseases) and CPT (Current Procedural Terminology) standards. Once completed, the doc is viewed by a coding quality team to spot mistakes and inconsistencies. Each doc go through multiple stages of quality checks.
04. Charge Creation
After the quality team validates the code, our medical billing team creates medical claims in strict adherence to rules pertaining to the specific payers and local state rules. The claims creation process is usually created within 24 hours of clearance from the coding quality team.
05. Medical Claims Audit
The final emergency claim docs undergo an extensive auditing session which involves meticulous checking at different stages. In each of the stages the claims are once again checked for complete and relevant information, correct diagnosis and procedures and proper assigning of codes. This is to ensure that the claims do not get rejected because of submission of incorrect/incomplete details.
06. Claims Transmission & Claims Submission
After a thorough and final check, the emergency medicine claims are sent to the claims transmission department for submission. Here, once again a check is carried out to ensure all the supporting documents needed by the submission team are in place.
The submission team verifies the emergency medicine documents and submits it to the respective insurance agencies and government departments. All supporting documents are scanned and uploaded along with the relevant information for final settlement. The submissions are done by claims submission specialist specializing in handling different payers.
07. Follow-up and Settlement
This is the concluding and arguably the most important part of the emergency medicine billing process. Our follow up team chase insurance agencies every day to understand the status of the claims submitted. We stay in touch with the agencies and insurer till the final settlements on the claims are made.
Software We Use
Flatworld uses a wide range of medical billing software that eliminate the need for additional resources to handle repetitive tasks. We automate as many functions possible using the following software -
Other Healthcare Support Services You May Benefit From
Why Outsource Emergency Medicine Billing Services to Flatworld Solutions?
We offer our services at very competitive pricing, which is why our clients have been able to realize huge cost savings. We assure up to 60% cost savings to our clients. At the same time our well-oiled process ensures you get paid on time and have continued cash flow.
Our emergency medicine billing process is marked by complete transparency. We help you lay your hands on any data and reports 24 hours a day. This empowers our clients with absolute sense of control and unhindered access.
As a premier emergency medicine billing service provider, we keep ourselves updated on the latest changes in regulations and requirements. As a result, we help you always stay compliant and ensure the submission of clean claims.
We have over 20 years of experience in handling emergency medicine billing service for small and large hospitals and clinics. In all the emergency cases we have helped our clients submit accurate bills and get full reimbursements in the shortest possible time.
We have an expert team of AAPC certified, dedicated, and experienced medical billing and coding professionals. All our professionals have over 5 years of multi-specialty coding experience which is why they are well-versed in medical terminology and billing.
We have a dedicated team to handle every process. Our dedicated team handles complex claims like oncology and chiropractic billing. We also have great expertise in emergency medicine billing which includes coding and reviewing.
Our emergency claims process is handled by professionals with years of experience with each payor types. These include Medicaid and Medicare. It is our experience in these areas that give us an upper hand in understanding of each Payor requirement.
Guaranteed Accuracy Levels
We have a track record of around 98% accuracy. All our clients have benefited with our services by way of a steep fall in the number of rejected or denied claims due to medical billing errors. We guarantee this accuracy standard to all types of billing including emergency medicine billing services.
Client Success Stories
FWS Provided Accounts Receivable & Full-service Billing Service for an Emergency Medical Practice
We enhanced revenue generation for an emergency care hospital by undertaking its medical billing tasks to lower the overhead costs. We successfully shrank AR days from 34 to 20 days.
FWS Provided Medical Billing and Accounts Receivable Management Assistance to a US Client
We helped a US based clinic by lowering its AR days were from 34 to 23 days. In just 6 months we increase the collections from 53% to 61%.
Why Outsource EMS Billing Services to Flatworld Solutions?
After several days of monitoring the encounters, I believe your team has done a great job and we are ready to hand over the task of approving the encounters. I truly appreciate how smooth this process has been. Keep up the great work!Spokesperson,
Healthcare Service Provider, USA More Testimonials »
We have experience working on huge volumes of emergency claims processing. For each client we have worked on different software systems mostly the ones preferred by them. Our healthcare BPO operations are highly flexible and scalable, and we are ready to take any volume of work and submit them with accuracy at the end of the day. No matter how big your work requirements are we will be sending you daily and weekly reports of the emergency medicine billing and payment status. Our commitment to providing customers with the timely and precise billing services is proven and established.
Contact us today to outsource your emergency billing requirements to emergency medicine billing experts and see fewer claims denial.
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