Billing Procedures

137.00 BILLING PROCEDURES

There are hundreds of different insurances that we bill, as well as several different methods in which we utilize to bill.  The following is a description of the methods we use, as well as instruction on how to use them.  The billing process begins once the call and patient data have been entered accurately and completely. Coloma Ambulance accepts assignment with Medicare and all other insurance companies, and will bill our residents for copays and deductibles after all other resources have been exhausted. If a resident’s insurance denies a claim and we are unable to resolve the problem, we will contact the resident to explain why we are billing them personally for the transport.

 

137.01 Medicare-  To create Medicare claims electronically, click billing and click electronic submissions.  In the pop up window under ECM, click the arrow down button and select MEDICARE ECM, click OK.  Once the claim has been generated another window will pop up.  If any claims have failed they will be documented at the bottom and can be viewed by clicking Show Failed.  Failed claims will be listed by run number and this report can be printed by clicking on the printer icon.  For the claims that have generated correctly, click OK and a Submission Batch Report will be printed.  The report will list the name, call number, and amount billed to Medicare.   After the claims have been successfully generated, the computer will update the schedule on each of the calls and will automatically rebill them if they are not paid within a pre-defined amount of time.  To send the claims, go the the desktop (from billing person computer) and click the Medicare.ht icon.  Click OK in the pop up window for the number to call, and in the next window click DIAL.  Type in user ID:  67091.  Password is 600cea.  Select 2 to upload files.  Select 2 for production files.  For the file to upload, and eight digit number is required followed by '.dat'.  Add zeros to the beginning of the batch number listed on the batch report to get all eight digits.  Select Z for Z modem.  Click Transfer and select Send File.  In the pop up window under file name type in the eight digit number plus '.dat' and hit enter.  Select X to exit.

137.02   Medicaidto generate Medicaid claims follow the same directions as for Medicare except select ANSI Medicaid MI from the drop down box.  To send the claims, go the the desktop (from billing person computer) and click the BCBSMichigan.ht icon.  Connect the same way as explained under Medicare section.  Type in ID:  c0dzk.  Type in the password that was previously assigned.  Select U to upload, and Z for modem. Click Transfer and select Send File.  In the pop up window under file name type in the eight digit number plus '.dat' and hit enter. 

137.03  Blue Cross Blue Shield Electronic- to generate BCBS electronic claims,  follow the same directions as for Medicare except select ANSI BCBS MI from the drop down box.  BCBS claims can be sent at the same time as Medicaid claims.  Once the first claim is sent, hit enter then type in Z for modem.  Click Transfer and select Send File.  In the pop up window under file name type in the eight digit number plus '.dat' and hit enter.  Once the second claimhas been sent, hit enter then type G for goodbye.

137.04  HCFA 1500 Forms (Insurance)-  to generate paper claims for insurance companies, click Billing then Print Forms.  Select BCBS CMS 1500, and click OK, and click OK again.  Follow the same steps and select HCFA 1500.  MEDICAID CMS 1500 and MEDICARE CMS 1500 will also need to be printed, if there are any.  This will print all of the ambulance insurance claims that are due, and will also update the Event on each of the calls.  If they are not paid within a certain amount of time, the computer will automatically flag them to rebill after the specified amount of time has elapsed. 

137.05  Private Pay Billsclick Billing, select Print Forms.  In the drop down box, select PATNT CARE-A-VAN and click OK.  Click OK again.  Follow the same steps to print ambulance bills except select SINGLE TRIP INVOICE.  Every Monday additional bills will need to be printed.  They are as follows:  Ltr 01 - Reminder Ambulance, Ltr 01 - Reminder Van, Ltr 02 - Ins. Remain Bal Amb, Ltr 03 - Ins Denial, Ltr 05 - No Ins, Ltr 09 - BPTP, Ltr 10 - Further Action Amb, Ltr 10- Further Action Van, Ltr 12 - Ins Pay Patient, Ltr 13 - Ins No Respond.

137.06  Contract Statementsfor all the facilities we provide ambulance and wheelchair transports to, we bill them monthly, ensuring that the bills are sent out by the fifth of each following month.  To do this, go to Billing and select Print Form.  In the drop down box select FACILITY INVOICE CARE-A-VAN.  Change the dates to the first of the previous month and the last day of the previous month.  On the top right click in the box to check Restrict trips selected to certain criteria.  Under that in the Payor field, type in the payor to print.  This will need to be repeated for all facilities we provide transportation.  To print ambulance facility invoices, select FACILITY INVOICE AMBULANCE and change the dates as described above.  For ambulance you do not need to restrict trips by payor as there usually isn't that many and it will not cause the computer to freeze up.  You will then need to pull the following statements, because they need additional forms or summaries.  Any of the remaining statements may be sent.

 

137.07  Area Agency on Agingfor this contract, they require that we fill out a monthly voucher for each individual client.  To do this we take the contract statement generated from our billing program, and fill in the amount of units underneath the box for each day of the month. Attached is an example of what the completed form should look like.  After the forms have been completed for the month, a total page is then required that lists the amount of units as well as the total dollar amount for their account.

 

137.08  Burnam Brook Centerfor this contract, you are also required to fill out a monthly voucher form almost identical to Area Agency’s.  The method is the same, requiring a total page for the units and dollar amount.

 

137.09  FIA/DHS Transportation Clientsfor these accounts, FIA requires that we fill out a MSA-4674 form.  The Care-A-Van driver is responsible for obtaining the Beneficiary (patient) and Medical provider's signature at the time of transport.    He or she should also fill in the name and address of the patient and the name and address of the medical provider if they didn't.  Before sending  the form in, verify Section I has the patient name and address.  Section II should have the provider name or facility and address.  Section III should already be completed.  Also verify all three signatures have been obtained.  For patients that are straight FIA, the form can be sent to FIA.  For those patients set up through Area Agency where Area Agency agrees to pay any balance after FIA pays, the forms must be sent to Area Agency for review.  They will then forward them to the appropriate FIA office.

137.10  Watervliet Community Hospitalthis contract utilizes several different departments, therefore we separate each individual department with a cover sheet, and provide a total page generated from our Windows program.  For the 'outpatient' portion of the bill, another report needs to be generated which will list each patient and all the dates they were transported.  To create this form, click Desktop in the upper left corner, then select RescueNet Reporting.  Click the '+' next to billing, then click the '+' next to aging.  Locate Aging Detail Report (Patient/Trip Date) and click on it.  Click on Trip Date and change the dates to the month you are billing.  Drop-Off Facility needs to be COMMUNITY REHAB CENTER, Current Payor needs to be WATERVLIET HOSPITAL, and Call Types needs to be WA - AMBULATORY VEHICLE and WN - NON-AMBULATORY VEHICLE.  To print, click the printer icon.  The total on this report should match the total on the outpatient portion of the bill.  If it does not, you will need to go through the outpatient portion of the bill and locate any transports that originated from CRC as these will not be included on the second report.  They will need to be written on the Aging Detail Report and the total revised.

 

137.11  Lakeland Regional Medical Centerthis contract utilizes several different departments, and we also separate each individual department with a cover sheet and total page.

137.10 Mutual Aid Fees- when providing Paramedic services to BLS agencies on a mutual aid basis, bills will go out to the BLS service on the next business day. The fee for this service is $150.00.

 

HJ 10/06