Among the many challenges associated with providing non-emergency medical transportation services is the issue of billing and reimbursements. Due to the increasingly complicated regulations and processes mandated by states and medical funding sources, providers are constantly struggling to control their revenue streams while ensuring that they adequately match their costs. Business success depends upon a provider’s ability to get paid in a timely fashion. The longer a bill sits unpaid in accounts receivable, the fewer resources that provider will have on hand to deal with current issues. NEMT software can serve as a solution for managing accounts by dealing with the main issues that cause a denial of claim or otherwise impede the reimbursement process.
How Can You Prevent the Denial of a Claim?
At every juncture, information can be used as the basis to deny claims. What are you doing to deal with this situation in your operation? Looking at the example of this 2013 West Virginia Legislative Auditor’s Agency Review, the top 3 main reasons for denial of claims from 2010 until 2012 were:
- Provider billed amounts for NEMT that were not appropriate for the time span submitted
- Duplicate claim – same recipient
- Medicare is primary payer of claim – not Medicaid
A claim denial is highly detrimental and a potential complete financial loss. Some denied claims may never be resolved. But even a lengthy resolution to the reimbursement process can be a problem by hindering a provider’s ability to plan. For example, how can they adequately consider future growth if they don’t know their current cash flow? Should they hire new staff? Should they expand their fleet? What maintenance is mission-critical and what should delayed?
Various Solutions for Improved Billing Processes
Over the years, solutions have been proposed at the organizational level in order to speed up the reimbursement process. However, in the end, it comes down to communication. Providers need to communicate more effectively with brokers, medical facilities and state provided payment systems. Timely billing requires having immediate access to eligibility requirements, service delivery data and each provider’s claims management system. NEMT software provides an integrated database where these vital pieces of data can be stored and recalled. At trip booking time, the data made accessible from a NEMT software solution helps to prevent errors traditionally associated with manual data entry.
NEMT Software as a Total Solution
Every provider needs to prove they are eligible to provide services and that every recipient of service is eligible for Medicaid benefits. And of course, all the information submitted needs to be correct, and everything appears in order, such as:
- Correct service identifiers
- Correct procedural codes and modifiers
- Non-duplication of trips
- Medicaid eligibility on the actual date of service
- Overlapping coverage from Medicare
NEMT software coordinates scheduling of multiple services and helps to determine optimal routes based upon each client’s personal information. But from a claims and reimbursements standpoint, a database of client information can also help to guarantee that each trip is booked and provided in good faith. An integrated client management system is insurance against the possibility that a client may be found ineligible later on.
So how much do you lose every year on denied claims? How much of your budget is locked in the unpaid column of your accounts receivable? Discuss these questions with a NEMT software specialist and learn how easy it is to implement a solution. This is essential business planning for any operation that hopes to grow and strengthen their service offering.