Reimbursement Management and Processing Services

The Reimbursement Management Services of AmbCoach consists of six (6) departments, all located under one (1) site and under the direction of Kimberly M. Walk.

These six (6) departments, Customer Service, Preverification, Data Processing, Fiscal Affairs, Aged Accounts Management, and Collection Preparation, perform both specific and overlapping duties in the processes of converting field work to cash. This process has six (6) components (steps) for paperwork to flow through on its journey from field work to invoice production to payment.

STEP ONE: PREVERIFICATION

All paperwork from the field is reviewed daily for completion, i.e. signature authorization, insurance information, subscription/membership information, medical documentation indicative of medical necessity, etc. and prepared by Patient Account Representatives for entry or electronic acceptance into the billing system.

STEP TWO: DATA PROCESSING

Data Entry Specialists key or upload patient demographic and trip information into the system. Appropriate billing formats (Private Pay, Medicare, Medical Assistance, Contract Statement, etc.) are produced daily. Tripsheets without significant insurance information or signature authorization are processed as Private Pay invoices and sent to the patient or responsible party for the completion of the appropriate information. All electronic means of data collection are exhausted prior to patient billing.

STEP THREE: AGED ACCOUNTS MANAGEMENT

Accounts identified by Commercial or Program payor coverage are followed-up with both phone calls and tailored dunning letters, both to the patient and insurance company, (where appropriate) who is generally responsible for producing a timely turnover on these accounts. Both telephone contact and progressive collection letters are used in the process of Private Pay invoices. Cooperative, but financially distressed patients are encouraged to enter installment programs, under the supervision of the Claims Review Manager. Uncooperative patient accounts are referred back to the transportation provider for further collection consideration. Private Pay account management follows a rigorous time limitation with final notices given between sixty (60) and seventy-five (75) days, unless otherwise negotiated for client specified timelines. Timelines may be expanded predicated on changes to the ACA, FDCPA, or new rules based on legal action settlements.

STEP FOUR: FISCAL AFFAIRS

All incoming patient account payments are posted within forty-eight (48) hours of receipt. The methods of providing account payment information for posting are as follows:

1. Client agrees to establish a depository account with a bank local to the AmbCoach office.


2. Client agrees to utilize a bank lockbox depository account at a bank of Client’s choice.


3. Client agrees to receive all payment E.O.B’s and Remittance Advices and forward copies of all such information to AmbCoach in a timely manner for cash posting purposes along with bank deposit verification.


4. All payments against patient accounts will be received at AmbCoach in the name of the Client. Weekly AmbCoach will forward to Client all payments and corresponding reports of cash posting.


5. Client will provide to AmbCoach a remote capture deposit machine from Clients’ bank for daily deposits to Clients’ bank account.

Each days posting is cross-checked with daily cash receipts journals. This procedure provides each Client with an accurate daily audit trail of cash receipts.

Under the direction of the Claims Review Manager, notification of all overpayment refund requirements are forwarded to the client for the distribution of funds. No posting transactions are entered without the receipt of proper documentation of proof of the distribution of funds from the client.

Reimbursement of all Program payors is overseen by the Claims Review Manager who is responsible for the rebilling of and medical review of these claims, when appropriate, to assure program adherence of the Division’s policies and procedures as set forth by CMS, the Part B Carrier(s), Dept. of Public Welfare-Office of Medical Assistance, and other Program payors.

STEP FIVE: COLLECTION PREPARATION

Activity for Private Pay accounts exceeding seventy-five (75) days of age deemed to be uncollectable due to patients failure to cooperate, failure to comply with pre-established payment schedules, and/or failure to respond to written correspondence or telecommunication (this includes returned mail due to bad addresses) will be referred to the Client for collection consideration, unless otherwise negotiated for Client specified timelines.

Collection agency referrals are done only by written client authorization to the Collection Agency of the Clients choice.

STEP SIX: QUALITY ASSURANCE

Daily, weekly and monthly reviews are performed on every aspect of the process, under the control of the Claims Entry Manager, Claims Review Manager and the General Manager. Standard A/R management tools (aged accounts ledgers, daily transaction journals, sales analysis, etc.) are produced and reviewed to monitor effectiveness of the collection effort. Many reports may be modified to provide more detail into a specific area. Trends are analyzed and corrective precautionary measures are taken in processing enhancements in the effort of efficiently and effectively maximizing the reimbursement for every account under lawful provisions.