CAC Course Topics
Course 1 – Ambulance Billing Basics
Course 1 provides an introduction to the basics of ambulance billing and the core fundamentals that must be clearly understood in order to accurately interpret the information provided by those in contact with the patient.
Lesson 1A – Introduction and Overview
Lesson 1A focuses on general concepts regarding the duties and responsibilities of an ambulance biller, including the roles each department within their organization plays in achieving accurate, timely and compliant billing, as well as the significant penalties for incorrect billing.
Lesson 1B – Anatomy/Physiology/Terminology
Lesson 1B covers basic human anatomy and physiology, as well as terminology used in the typical Patient Care Report.
Lesson 1C – Dispatch/Call Intake
Lesson 1C examines the important roles that Dispatch and Call Intake information play in determining the proper levels of service to bill. This lesson also discusses Advance Beneficiary Notices and Physician Certification Statements, and the role that effective Call Intake plays in compliant billing.
Lesson 1D – Crew Documentation
This lesson discusses the primary source of ambulance transport documentation, the Patient Care Report (PCR), and the several disparate requirements and uses of the PCR for the different departments of the ambulance company; with a strong focus on compliant PCR based billing.
Lesson 1E – Signatures & Forms/Beneficiary Signature Rules
A proper understanding of the beneficiary signature rules is critical to proper billing of Medicare, the largest single payor for most ambulance services. Here we cover all of the complex issues surrounding required signatures including who can sign on the patient’s behalf, and when.
Course 2 – Ambulance Coding and Claims Submission
In Course 2 we discuss coding for the proper representation of the information provided by the care givers, as well as the claims submission process.
Lesson 2A – Pre-Billing Verification/Claim Production
Lesson 2A covers the process of verifying that all of the information necessary to properly bill the claim has been obtained, as well as the process of turning the information collected into a payable claim.
Lesson 2B – Levels of Service
In this lesson we discuss, in detail, the various levels of ground and air ambulance service and what determines the proper level to bill.
Lesson 2C – Modifiers
Origin modifiers, Destination modifiers, as well as several “Second modifiers” are vital to proper billing, including facilitating proper claims adjudication in situations such as billing for a proper denial.
Lesson 2D – Condition Code
Unlike billing for other medical specialties, ambulance billing is not based on a definitive diagnosis. This lesson covers the concept of treating a patient based on their apparent condition, rather than based on a diagnosis, and the proper coding of a “condition” based claim.
Lesson 2E – Claims Submission Formats/Issues
This lesson discusses National Provider Identifiers, as well as paper claim submission vs. electronic claim submission, including some pros and cons of each, and some times when you have no choice.
Course 3 – Specific Payor Issues
In addition to the general policies of ambulance billing, some types of Payors have their own complex rules that the ambulance biller must be familiar with.
Lesson 3A – Medicare
For most ambulance services, Medicare is the single largest payor. Medicare is also the payor with the most complex rules and the harshest penalties for improper billing. It is important to remember that Medicare is not an insurance, it’s a Law!
Lesson 3B – Medicare Managed Care
Here we discuss this latest twist on Medicare, the Managed Care plans.
Lesson 3C – Medicaid
Medicaid is managed by each State, so rules vary widely. Some of the challenges discussed include short “timely filing” periods, retroactive eligibility, Medicaid Managed Care, and Transportation Brokers.
Lesson 3D – Facilities
When is a Facility responsible for payment for the transport? Which facility is responsible? This session also discusses such topics as contracts, Hospice and the anti-kickback statute.
Lesson 3E – Commercial, Self-Pay & Other Payor Issues
In this lesson we will discuss Commercial Insurance, including Auto Insurance and Workers Compensation. Also covered are Self-Pay issues such as time payments, finance charges and hardship discounts.
Course 4 – Follow-Up
Getting the bill properly coded and out the door is only half the battle. The key to a successful ambulance billing office is prompt and consistent follow-up.
Lesson 4A – Posting & Remittance
In this lesson we discuss the importance of properly understanding the Remittance Advice that accompanies insurance payments and the payment posting process, including recognizing incorrect payments and secondary billing of billable balances.
Lesson 4B – Denials & Appeals
Another important duty of the ambulance biller is dealing with claims that are denied rather than paid, as well as understanding when the denial is appropriate and when it should be appealed. We will also discuss the importance of understanding the appeals process and protecting your rights of appeal.
Lesson 4C – Collections
We will discuss internal collections vs. external collections and the laws regulating collections. Also covered will be patients represented by attorneys and bankruptcy issues.
Lesson 4D – Accounts Receivable Management
This lesson will discuss effective A/R management, from understanding your payor mix to maximizing your software utilization. We will discuss setting good standards and then effectively monitoring performance.
Course 5 – Compliance
In course 5 we will cover all of the compliance issues that an ambulance biller must be familiar with to prevent devastating fines and legal action toward their ambulance service and themselves.
Lesson 5A – False Claims/Kickbacks
This lesson covers legal sanctions for violations of Federal health care program requirements. We will discuss the statutes themselves, areas of risk, the enforcers and the various penalties for violations.
Lesson 5B – Internal Auditing & Claim Review
This lesson will discuss the importance of internal auditing and claim review programs, as well as some effective ways of meeting these needs.
Lesson 5C – HIPAA Privacy, Security and Confidentiality
Few laws have impacted day-to-day operations in an ambulance billing office the way HIPAA has. We will cover all of the important rules and regulations that the ambulance billing staff need to be aware of to insure compliance with these standards.
Lesson 5D – Compliance Programs
In 2003, the Office of Inspector General (OIG) issued its “Compliance Program Guidance for Ambulance Suppliers”, making it clear that all ambulance services should implement formal compliance programs. In this lesson we’ll further explain why you should do this and how.