Expert EMS Billing

Solving the Deductible Dilemma with Automation

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At Digitech, we don’t see problems—we see opportunities. When a client brings us a question or a problem, we turn it into a challenge. How can we develop a solution that will become a benefit to all who we serve? Can we increase efficiency? Can we write new software that eliminates a roadblock? Can we chart a path through the maze that will lead others out of the same trap?

Take the problem of increasing deductibles in healthcare insurance programs. With costs for health insurance pushing a greater portion of the burden onto the patient, it’s naturally gotten harder to collect ambulance billing claims. Some billing companies might shrug and say, “Well, we’re just going to have to live with a reduction in insurance collections and an increase in self pay claims.”

Not here.

At Digitech, we got to work. We’ve rolled out new automation that enables our verification process to check the deductible information on commercial insurance coverage on a case-by-case basis. For those payers that provide this information, it will be captured in the claim record and will allow us to see whether that claim will hit the patient’s deductible. When a significant portion of the bill may get pushed to the patient, we can hold the claim for a period of time to allow for a greater chance for the deductible to be met. This process is in addition to our standard process of holding Medicare and some Medicare HMO claims for deductibles.

The goal here is the one that Digitech always pursues, while keeping a sharp focus on compliance: Maximized revenue for clients and minimum distress for patients.

Going forward, all Digitech clients can opt in to this program. We’re ready for you! Please reach out to your account manager at Digitech to opt in to deductible eligibility checks and we will get the ball rolling for your service.

You may also contact the Digitech team at accountmanagers@digitechcomputer.com.

Ambulance Cost Data Collection Update

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The ambulance industry has been abuzz about cost data collection requirements set forth by the Bipartisan Budget Act of 2018. As the system continues to develop, we will provide updates about the timeline, any modifications to the requirements that may arise, and how you can take action. Read on, or download this information as a PDF.

What is the purpose of H.R. 3729, the “Comprehensive Operations, Sustainability and Transport Act of 2017?”

  • Medicare Ambulance Add-On Payments, an important supplemental reimbursement source from Medicare, expired on January 1, 2018.
  • Congressional action was needed to restore the add-on payments and they were extended with some reductions by the Bipartisan Budget Act of 2018 until December 31, 2022).
  • There is a current lack of cost reporting data among suppliers of ground ambulance services.
  • This legislation would help CMS understand how much it costs to provide ground ambulance services to Medicare beneficiaries.
  • This act would reauthorize the add-on payments for five years as well as create a cost-reporting system that will lead to improvements in the Medicare Ambulance Fee Schedule and adequate payment rates for Medicare transports.
  • H.R. 3729 will authorize CMS to design and launch a cost reporting system.

What does the implementation look like?

  • Pre-Rulemaking — CMS will engage stakeholders to solicit recommendations.
  • Rulemaking — CMS will publish a proposal for collecting cost data then seek public comment.
  • Final Rule — CMS will issue a final rule after reviewing public input.
  • Launch — CMS will select ambulance services to submit data.
  • Phase One — All ambulance service suppliers will provide data on the characteristics of their operation such as the type of supplier (e.g. volunteer rescue squad, private company, third service, etc.).
  • Phase Two — A survey will collect cost data from a statistically significant number of each group of supplier and provider to obtain costs and other data.

What will this mean for ambulance service providers who are selected to provide data?

  • This is not like Medicaid cost reporting, state reporting, or GEMT reporting.
  • Costs for providing services vary greatly due to differing state, local, and agency protocols like bundling.
  • Different providers have different fee structures and CMS needs the whole range.
  • A representative sampling of providers will be selected to report cost, revenue, utilization, and other information as determined by CMS.
  • Data will be collected each year from 2020 through 2024.
  • Cost reporting will continue at least every three years from 2025 on.
  • Future reimbursement will be dependent on the accuracy and completeness of the data compiled.

How can you take action?

How can Digitech help you?

If you are selected, Digitech will support you through the cost data collection process by providing relevant revenue data and other resources and tools. Our reporting and data mining systems will ease the delivery of required revenue data for our clients. If you have questions about what this all means and how it may affect you or your service, do not hesitate to reach out to us.