Non-emergency transports were dying at the payer. We found missing Physician Certification Statements and wrong origin and destination modifiers, then fixed both at dispatch. Days in AR fell from 71 to 38 in one quarter.
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King-American Ambulance Company is a San Francisco based emergency medical services provider running a mixed caseload of emergency response and scheduled non-emergency transport.
Emergency transports were being paid. Non-emergency transports were not. Days in accounts receivable sat at 71 and the gap between what was billed and what was collected had become large enough to affect fleet planning. Luxen took over the revenue cycle and started with the transports that were failing.
The challenge. Almost all of the loss was concentrated in scheduled non-emergency transport. Two causes accounted for the majority of it.
First, Physician Certification Statements were missing or incomplete. Payers require documented medical necessity for non-emergency transport, specifically why the patient could not safely travel by any other means. Crews were documenting the transport accurately but not in the form the payer needed to see.
Second, origin and destination modifiers were being applied inconsistently. These two-character codes tell the payer where the patient was picked up and where they were taken, and a wrong pairing produces a denial regardless of how well the rest of the claim is documented.
A third, smaller group of denials came from level of service, where basic and advanced life support billing did not match what the patient care report supported.
What we did. We worked the aged accounts receivable first, appealing the transports where documentation existed and could be assembled after the fact.
Then we moved the fix upstream to dispatch. Physician Certification Statements are now collected before a scheduled transport rather than chased after the claim is denied. Origin and destination modifiers are set at the point of scheduling, where the answer is already known, rather than reconstructed later by a biller reading a report. Level of service is checked against the patient care report before submission.
The practical change is that the information the payer needs is captured while the crew is still in front of the patient, which is the only point at which it is easy to get.
King-American kept its existing systems and payer contracts throughout. Luxen worked inside them. See how the process runs, or book a billing review and we will tell you what your own ageing looks like.
"We were being paid for emergency runs and not for scheduled ones, and nobody could tell us why. Luxen found it in two weeks and fixed it at dispatch instead of at the claim."
COO, King-American Ambulance Company
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