11-09-20 Regular Meeting of the La Porte City Council

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EMS Billing Services City of La Porte RFP #20510 Step Two:We request face sheets, payer information, demographics, and any other missing data from the receiving facility by fax, phone, or mail. If information is not received within 24 hours, an EMERGICON staff member calls the facility. If information is still not received within 48 hours, the request is re-sent,and the staff member calls the facility again. Step Three:Each claim is reviewed, coded, and billed electronically through the MD Online clearinghouse. Medicaid claims are billed electronically through their designated site to reduce denials and expedite payment. Step Four: EMERGICON conducts follow-up and claim analysis as follows: Medicare:Medicare claims may payby electronic remittance in as little as 14 days. On the th 15day, we review and verify the status of any unpaid Medicare claim. We call Medicare to obtain the status of the claim. Then, we appeal or refile the claim as needed. Finally, we issue a Medicare co-pay statement for the 20% patient responsibility. Commercial Insurance: The payment of commercial insurance claims typically takes 3545 days. If 40 days pass without payment, our staff will reach out to a live agent to discuss the status of the claim. EMERGICON staff draw on years of experience communicating with commercial insurance carriers to decrease delays in payment and improve cash flow. Medicaid:Medicaid claims are filed electronically and paid within ten working days. Claim status is accessible online and can be appealed immediately online. Private Pay: Private pay patients are sent a Private Pay statement requesting insurance information within five days of the date of transport and notifying them of the balance due. If a statement is returned to our office due to a bad address, we use skip tracing tools and verify Step Five:We carefully review claim payments, explanations of benefits, remittance advice, denials, low pays, and no pays. Medicare and Medicaid claims are reviewed and expected to pay from the approved federal and state schedules. As payments are posted, the contractual allowance is posted for Medicare and Medicaid accounts. Patients will have received an Explanation of Benefits and should have a better understanding of their obligation for payment. While other billing companies may allow contractual allowances for commercial insurers, we identify these low pays and appeal each one with the commercial insurer. This results in rectification by the The Director reviews each denial and seeks rectification. We also use each denial as alearning experience to continually improve our processes. 12 Confidential & Proprietary