Imagine navigating a complex web of paperwork and regulations, only to find your NEMT business stuck in neutral due to billing inefficiencies. The journey to successful reimbursement doesn’t have to be complicated. By understanding the billing process, you can unlock the full potential of your NEMT services.
This guide breaks down the seven essential steps to streamline your billing, ensuring your operation runs smoothly and efficiently. From trip completion to payout, we’ll explore how to avoid common pitfalls and maximize your reimbursements.
Seven Steps in the Billing Process
Step #1: Trip Completion and Documentation
- Once a trip is complete, document all details, such as member information, trip completion data (pickup and drop-off times, mileage), and the purpose of the trip.
- Ensuring that all documentation is accurate to avoid claim denials.
NEMT Tip: Implement a robust documentation system using GPS tracking to ensure accurate trip details. Regularly review trip logs for discrepancies before submitting claims.
Step #2: Claims Preparation and Submission:
- To prepare a claim submission, review the appropriate reference codes that payers like Medicaid or insurance companies can process.
- Submit claims using electronic billing systems like the 837 Professional Transaction for medical transportation claims.
NEMT Tip: Utilize billing software that verifies codes before submission.
Step #3: Claims Acknowledgement
- The payer will then acknowledge the receipt of your claims and inform you about the next steps. For EDI services, this is accomplished through a 999.
- This step is paramount as it confirms that your claim is being processed.
Step #4: Claims Evaluation
- Payers will review your claim for accuracy and verify member eligibility and medical necessity of the transport.
- Accurate documentation helps to avoid delays or denials.
NEMT Tip: Ensure every trip has complete and accurate service records so your services match your billing codes, such as billing for a wheelchair trip versus an ambulatory trip. Use digital systems to store and manage member data efficiently.
Step #5: Appeal Process (if needed)
- If a claim is denied, submit an appeal with supporting documents to justify the claim.
- The payer reviews your appeal and makes a final decision.
Step #6: Claims Decision
- If your claim is approved, you will receive a remittance notice detailing the payment amount. For the EDI system, this will come in the form of an 835.
- If denied, review the claim, correct errors, and resubmit.
What is a remittance notice?
A remittance notice, or remittance advice (RA), is a document or electronic message that informs healthcare providers about payments received from insurance companies or other payers and notifies the recipient that payment is on the way.
NEMT Tip: Establish a timely submission process by designating a billing manager to ensure timely claims are processed. Automated billing software can streamline the submission process and avoid late submissions.
Step #7: Payout
- Approved claims result in payment via methods like Electronic Funds Transfer (EFT) or checks.
Claims Management
Tracking Claim Status: Comprehensive NEMT software will help monitor the status of your claims in real time.
Managing Denials: Archiving all trip completion data and documentation will help identify and correct errors promptly. At the end of the day, we want to get paid, so making the proper corrections promptly is vital.
Ensuring Compliance: A TP must stay updated on Medicaid and insurance regulations to avoid compliance issues.
Get on the Path to Efficient NEMT Billing
Navigating the billing process for NEMT can be daunting if you don’t know where to start. With the right strategies and tools, however, you can elevate your business into a well-oiled machine.
At Momentm, we understand NEMT providers’ challenges in managing their billing workflows. That is why we offer a comprehensive software solution designed to simplify claims management, track claim status in real time, and ensure compliance with Medicaid and insurance regulations.
Ready to take your operations to the next level? Request a demo today and discover how to streamline your operations, reduce administrative burdens, and focus on what matters most – providing exceptional member care.
