Last Modified: 12/10/2017 Location: FL, PR, USVI Business: Part A, Part B
Innovative providers use PDS reports to improve billing practices
“Using the trends spotted with the PDS report, we changed our process to improve our claims.”
Escambia County Emergency Medical Services
Escambia County Emergency Medical Services
Joe Scialdone regularly uses PDS reports to improve billing operations for Escambia County Emergency Medical Services.
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Each year over 32,000 people rely on Escambia County Emergency Medical Services (EMS) for transport to health care providers. Like many public agencies around the United States, the county’s EMS faces funding pressures to continue to serve their community at the level Pensacola area residents have come to expect.
Joe Scialdone, who manages Medicare billing for Escambia County EMS, says billing accuracy and timeliness are important to the agency’s ability to provide life-saving services for its residents. “Escambia County EMS does not receive an operating subsidy from the county, so it is critical that we accurately bill for our EMS services on our initial invoice,” Scialdone said.
To stay on top of trends, Scialdone uses provider data summary (PDS) reports from First Coast Service Options Inc. (First Coast). The PDS is a comprehensive billing report designed to help providers identify potential Medicare billing issues. The report gives a detailed analysis of personal billing patterns in comparison with those of similar providers.
Each quarter, he reviews PDS reports which show recent Medicare billing trends for the county as well as nearby agencies. “Getting to the reports is very easy,” Scialdone says. “It [PDS report] provides a snapshot of the quality of the claims we are filing,” he said.
Improving the bottom line
Scialdone points to two improvement initiatives where PDS reports helped the agency improve its processes and ultimately, the organization’s bottom line.
“We had a team goal to reduce the number of days between providing a transport service and filing a claim with Medicare. We wanted to make sure the quality of our claims did not suffer. The data from the PDS report helped us track the information to make sure we were not just pushing more claims into the system quicker,” Scialdone said. Ultimately, the team reduced the time from 13 days to three without an increase in the claim denial rates.
The second initiative grew from an increase in Medicare billing denials, which was spotted through Scialdone’s regular review of PDS reports. “We put together a hospice task team to review our procedures when we saw a spike in hospice claim denials. From our standpoint it is not always evident that we were transporting a hospice patient. We would arrive at the hospital and later find the patient was in hospice care. Using the trends spotted with the PDS report, we changed our process to improve our claims.”
“Now when we make the transport, we ask the hospice provider to sign a form that states the nature of the transport is related to end of life care,” Scialdone said. “We make the determination up front before the claim is filed and know whether to bill the provider if the transport is related to the hospice care or the Medicare Part B program if the reason for the transport is unrelated to the patient’s terminal diagnosis.”
Other online tools
In addition to PDS reports, First Coast offers providers other online tools for providers to improve their billing practices. Providers may use comparative billing reports (CBR) and the evaluation and management (E/M) interactive worksheet.
Providers may request different types of CBRs based on different criteria such as type of bill, provider-specific E/M distribution, or service specific distribution. The interactive E/M worksheet helps providers accurately bill E/M services provided to Medicare beneficiaries.
First Coast recommends providers use these tools to design and implement a compliance program to improve Medicare billing practices. For more information, First Coast offers tips for providers on how to develop a compliance program.
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.