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SPRING • 2015
SPRING • 2015
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IN THIS ISSUE
Welcome to The Pulse
Bill Harrod, Executive Director
Client Spotlight
Dashboards
US Coding Solutions
Tips and Tricks
In Other News...
News and Updates on
Community Paramedicine
Community Paramedicine
Fact Sheet
www.MarsBilling.com
www.AmbulanceRevenue.com
100 Fulton Court • Paducah, KY 42001
855-347-1360 • info@marsbilling.com
Ashley’s Corner
Employees / Supervisor of the Year
MARS / AMB
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the
From The Executive Director
Well it was my intention to start this letter off with
“winter has come and gone…”, but old man winter has
decided to sleep in this year and stick around. I say we
kick his sorry behind to the curb and bring on the Spring
showers, flowers and warmer weather!
I am pleased to announce and present to you our second
edition of the AMB/MARS newsletter Our main purpose
for these newsletter is to help educate and inform you
with what is new and evolving within the Healthcare
industry, AMB/MARS organization, and each localized
community.
Our newsletter, this quarter, will continue to focus on the
evolving changes in Healthcare and the implementation
of Community Paramedicine, Accountable Care Organizations, and the potential future of
Bundled payments.
On another note, AMB has undergone an extreme growth pattern over the last 6 months that
would rival any Fortune 500 company. We have literally increased cash collections by $95 Million
with the addition of 14 new partners to the AMB/MARS family. This continued record growth is
again due to the unbridled commitment and partnership that AMB/MARS shares with its clients
or “partners in billing. Without our partners, we are nothing.
To our current partners, rest assured. Our continue growth will benefit your organization with
extended knowledge of our billing industry and added benefits such as TLO scrubs, Passport
discovery, and other such performance tools to help bring more cash in the door.
We hope that you will find our newsletter informative. If you would like to contribute an article
or would like for us to provide coverage on a specific topic, please call me at 1-855-347-1360 Ext.
337.
Warmest Regards,
Bill Harrod, Executive Director
MARS/AMB, a division of Credit Bureau Systems
SPRING • 2015
Client Spotlights
O’Bryan Family Medicine
O’Bryan Family Medicine
has been open for just over 5
years and we have been with
MARS from the beginning.
Before that I did emergency
medicine for 11 years. I did
undergraduate at Murray State
and medical school at UK and
residency in Evansville, IN in
Family Medicine. I chose to be
a doctor because I wanted to help people and still be able
to use my scientific skills. My wife Ella and our 15 month
old daughter Fiona are at the practice with me every day.
Ella is one of my nurses too. So it truly is a “Family” office.
At O’Bryan Family Medicine, we are proud to be a small
office where we get to know each patient personally and
they always see me. I am able to spend more time with each
patient than is possible in larger offices and we like that our
patients all feel comfortable coming to see us, even the kids.
Recently we began offering several prescriptions for acute
illnesses available right in the office saving the patient a trip
to the pharmacy when they don’t feel well. This has been
much appreciated by many patients especially when they
have a sick child.
Marble Falls EMS
Marble falls EMS in Texas has been an AMB client since
early 2013. They are a privately owned and operated
ambulance service, and transport approximately 3000
patients a year. Jim Pearson has been the operating director
and has recently retired. They are proud and excited to
announce that they have chosen to promote from within for
the first time, and have chosen Kevin Naumann to take his
place. Marble Falls has a Bi annual Fish Fry @ Blue Bonnet
Café where their most recent fry raised 7,000.00 for charity
on October 2nd.
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New Clients
We are growing rapidly! We have added 14 more clients
since the last issue. We would like to proudly introduce
our new members of the family:
• Angel Care EMS LLC Services Started; 9/1/14 located in Savannah, GA
• Milan And Dummer Ambulance Services Started;
12/5/2014 - in Milan, NH
• Berlin Emergency Medical Services; Started
11/01/2014 - located in Berlin, NH
• Dekalb County Ambulance Services; Started
10/01/2014 - located in Smithville, TN
• Elite Ambulance Services Started; 10/20/14 - located
in Owensville, OH
• First Call EMT INC. Services Started; 10/15/2014
• Hocking County EMS Service Started; 11/1/2014 location in Logan, OH
• James M Hawkins MD Serves Started; 9/19/14 located in Paducah, KY
• City of Key West Fire and EMS Service Started;
4/1/2015 - located in
• Marshall County EMS Service Started; 8/1/14 located in Lewisburg, TN
• Nashville Fire and EMS Service Started; 12/1/2014 located in Nashville, TN
• Tran Star Ambulance Service Started; 11/1/2014 located in Prestonsburg, KY
• TriHealth Physician Practice Started; 10/14/2014 located in Cincinnati, OH
• Union County EMS Started; 10/01/2014 - located in
Lake Butler, FL
MARS / AMB
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the
Don’t Forget About the Dashboard
Don’t forget about the
Dashboard, where we
have made it easy for you
to review your financial
information. Please contact
us if you have any questions
regarding this new feature!
855-347-1360
SPRING • 2015
US coding solutions
We know accurate professional and facility coding is key to
maximizing revenue and compliance in the revenue cycle
process. Our vision and mission, then, are simple…provide
a quality coding solution with a level of service second to
none.Your facility or practice should expect nothing less
than a secure, quality effort. To assure we meet our vision
and your expectations…
• All services and personnel are based and performed in
the United States.
• All personnel are fully certified by AAPC, RCCB, AHIMA
and/or ACMCS and have a minimum of three years’
experience in their area of specialty.
• Single specialty coders.
• No additional fees or charges for documentation
feedback and deficiency listings.
• Our coders are always up to date to ensure strict
compliance with state and federal rules and regulations.
• Our internal compliance program assures quarterly
reviews of our coders to assure we meet and exceed
your high standards.
Dedicated coders and senior management are available to
your facility or practice 24/7/365.
ADVERTISEMENT?
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Tips and Tricks
Reviewing schedules ahead of time
Reviewing your schedule can be very beneficial. If you have
an office manager review the upcoming week’s schedule,
and the patients to be seen account information you might
be able to collect balances up front and update important
information which can be vital for billing.
Client info needed “bucket”
Did you know? There is a feature in JefBar where we
place tickets in which we need information from you to
process. This is called the client info needed “bucket” If
you go to your AMB web portal and select the “Ticket
Inquiry” button you will see the option to “Select Client
Info Required” with an arrow to select the “Drop-down”
box. If you will click this option and select “True” and
then click “Search,” it will pull up a list of Tickets that have
requests from our AMB staff.You will click on “Detail”
next to the Incident information provided and it will take
you to the run and you will be able to view all run details,
including the notes stating what we need from you in order
complete our billing process for that particular ticket. Once
you have completed the request you can send an email
to your Client Support Contact, Nikita Wheeler, and the
information will be updated, and the ticket removed from
your “Bucket.”
*Also review your fee schedules and if you need updates
please contact us
MARS / AMB
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In other News
Beginning 1/1/15, CMS will make a perbeneficiary-per-month payment at a rate of
$40.39 for CCM services provided to patients
with two or more significant chronic conditions.
Rather than create a new G code as proposed,
CMS is using the new CPT code 99490,1 with
the following description:
Chronic care management services, at least
20 minutes of clinical staff time directed by
a physician or other qualified health care
professional, per calendar month, with the
following required elements:
• multiple (two or more) chronic conditions
expected to last at least 12 months, or until the
death of the patient;
• chronic conditions place the patient at
significant risk of death, acute exacerbation/
decompensation, or functional decline;
comprehensive care plan established,
implemented, revised, or monitored.
the
CMS finalized its proposal to eliminate the
requirement that CCM services (as well as
transitional care management services) be
furnished under direct physician supervision
(i.e., physician present in the office suite), opting
instead for general supervision (no physician
presence requirement). CMS also clarified the
requirements for use of a certified electronic health
record (EHR) in providing CCM services, as well
as the requirements for an electronic care plan.
There are three core requirements a provider must
meet to bill for CCM:
• Secure the eligible beneficiary’s written consent
• Have five specified capabilities needed to
perform CCM
• Provide 20+ minutes of non-face-to-face care
management services per calendar month
I found the following link to be helpful: http://
www.pyapc.com/resources/collateral/white-papers/
Chronic-Care-Whitepaper-PYA.pdf
SPRING • 2015
NEWS and UPDATES on
Community Paramedicine
The $500 Million Idea
Medicare could save up to $560 million a year if CMS
reimbursed EMS for taking patients to alternative
destinations.
Gregg Margolis PHD NREMT-P director of the
Department of Health and Human Services Division of
Healthcare Systems and Health Policy and his colleagues
reached an estimated figure by determining how many
patients could be affected, then how much spending they
account for under current policies. Starting with 5% sample
of Medicare claims for 2005-2009, ambulance claims
yielded information on total costs of transports and service
levels provided. Linking each claim by beneficiary
number and service date to Medicare claims for
emergency department care and everything else
covered which provided a pretty accurate idea of
the total cost for transports and treatment. The
results of the study showed that 34.5% of 911
transports of Medicare beneficiaries had relatively
low cases that could possibility be managed
outside the ED. That is 15.6% of Medicare
covered transports to emergency departments.
Approximately 1 billion a year is spent on
these patients, with about 380 million of that
going to ambulance services. This provided the
approximate 560 million a year in savings.
Some concerns on the subject include
alternative destinations not being available to
patients needing non emergent care. Some
keep limited hours, some won’t take Medicare
patients, and some communities lack them
altogether. The ED takes all patients and this
may contribute to the overestimation of the
number of patients treated elsewhere. The
costs for emergent on average are higher
than those non emergent so using mean
costs might overestimate potential savings.
Another concern is the training that will
need to be provided, if even possible to
determine the patient’s level of care or
urgency per say. Can paramedics safely
identify in the field patients who would
need to be treated elsewhere is a question
still unanswered.
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North Carolina Grants Funding for
Community Paramedicine
As of December 2013, North Carolinas’ division of Mental
Health, Developmental Disabilities, and Substance Abuse
Services took the initiative to provide crisis prevention and
early intervention. They have acknowledged the role that
EMS holds in accessing and intervening when it comes
to a behavioral health crisis. The division has provided
funding to continue and support and expand the Crisis
Solutions Initiative. What they have done is created an
application that would help fund the development of
community Paramedicine programs. You can find all of
the community Paramedicine documents from the North
Carolina Administrators when you go to http://ncaemsa.
org/commparamedicine.html.
MARS / AMB
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Community Paramedicine
Fact Sheet
What is Community Paramedicine?
Community Paramedicine (CP) is a model of
community-based health care in which
Paramedics function outside their customary
emergency response and transport roles in
ways that facilitate more appropriate use of
emergency care resources and enhance
access to primary care for medically underserved
populations. CP programs typically
are designed to address specific local problems.
Interest in community paramedicine
has substantially grown in recent years based on the
belief that it may improve access
to and quality of care while also reducing costs.
Community Paramedicine fills healthcare
service gaps,without replacing healthcare
workers.
CP focuses on providing services, where access to
care is limited, or a short term
intervention is needed. By targeting locally
identified health care needs, and offering a
creative solution to fill local health care gaps, CP
helps to increase access to care, and
often reduces health care costs by providing the
right level of care based on the
individuals medical needs.
Community Paramedics are not
independent practitioners; they work
under clear medical control of a
physician, receiving direction and
supervision to ensure patient safety.
The Community Paramedic training program builds
upon the training and skill sets of
experienced paramedics. Additional training in
patient assessment, clinical skills and
familiarity with the other healthcare providers and
social services available in a local
community will all be a part of the required
training, and will lead to a more integrated
approach to health care delivery.
the
Where are there Community Paramedic
programs?
North Carolina, Colorado, Minnesota, Maine, and
Texas have implemented variations of
community paramedicine. These programs have
demonstrated that paramedics can be
trained to safely and effectively perform an
expanded role, with cost savings. An
example of this is the CP program in Fort Worth,
Texas, which is funded by healthcare
systems and provider groups on either a fixed
amount per visit or a percent of
demonstrated cost savings from preventable
emergency department visits or
hospitalizations. In Colorado a single county
program saved $1,250 per visit in health
care costs for each of its 29 patients in the first year.
California CP Pilot Program:
The California Emergency Medical Services
Authority (EMSA) is working in partnership
with the California HealthCare Foundation to
explore the implementation of community
paramedicine, utilizing the Health Workforce Pilot
Program option through the Office of Statewide
Health Planning and Development to test the
concept in California.
Visit OSHPD’s website to learn more about
HWPP and to review an Abstract of this
project at:
http://www.oshpd.ca.gov/hwdd/HWPP.html
SPRING • 2015
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ACTIVITY
TIMEFRAME
Health Workforce Pilot Project (HWPP) application deemed completed by the Office of
Statewide Health Planning and Development. 45 day review and public comment period
begins.
February 14 – March 31
Public hearing
May 12
Public meeting
April 9
OSHPD Directors Office approval or rejection of HWPP application #173
June 9
Core training begins for paramedics selected by each pilot site
August –September 2014
Local training begins at each pilot site
October‐November 2014
Community Paramedics provide services including post hospital discharge follow up, short
term home support for chronic conditions, and helping frequent 911 callers find primary
care services.
January 2015
How can I learn more about
Community Paramedicine?
Contact the Emergency Medical Services Authority (EMSA) for more information about California’s Community
Paramedicine pilot project, the goals and benefits of integrating Paramedics into the health delivery system and the long
term outcomes of exploring Community Paramedicine.
Lou Meyer
Project Manager
Community Paramedicine
Mobile: (209) 507-2386
Office: (916) 431-3709
Lou.Meyer@emsa.ca.gov
Lisa Witchey
Personnel Standards Manager
Emergency Medical Services Authority
(916) 431-3707
Lisa.witchey@emsa.ca.gov
MARS / AMB
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Ashley’s Corner
Community Paramedicine:
Beyond Emergencies
The healthcare system in the United States is
changing. We are seeing a true paradigm shift.
Prevention has become the goal instead of
reactive care once a disease process has started.
An integral part of this shift is also curbing the
overuse of our emergency services. We all know
that the emergency room is overused for acute
issues that could and should be more efficiently
and economically dealt with in a physician office
setting. According to a study conducted in 2010
by the RAND Corporation, between 14 and 27
percent of all emergency room visits were for
non-urgent care. In the years that have followed,
the percentages have more than likely increased.
Not only is this misuse of emergency services
driving up the cost of healthcare for everyone, it is
also detrimental to our communities. The overall
health of our community is going down. Without
preventative care, patients will wait until their
illnesses have progressed to a stage that requires
more intense treatment, up to and including
hospitalization.
EMS is playing a major role in this shift. Interest
in Community Paramedicine programs is growing
by leaps and bounds. So what is community
paramedicine? The model of community
paramedicine is driven by using Paramedics as
outreach healthcare providers. Depending on the
program, the Paramedics will help to establish
the
primary care for populations. The Paramedics
work under the medical direction of a physician
to assist their community. The duties can range
from assisting patients to obtain treatments
at home, such as outpatient IV antibiotic
therapy, to performing follow up visits with
recently discharged inpatients to ensure they are
recovering appropriately to help lower readmission
rates. Another beneficial aspect will be disease
management. Patients needing assistance with
diseases such as asthma and diabetes will have
medical professionals to not only assess them, but
also provide crucial education to help manage
lifelong illnesses that can lead to extended hospital
stays.
So where do these programs exist? Currently,
there are Community Paramedicine programs
in Alabama, California, Colorado, Minnesota,
North Carolina, North Dakota, Nebraska,
Pennsylvania, Texas, Washington, and Wisconsin.
There are several other states that have shown
interest in starting similar programs, including
Florida, Kentucky, and Maine. As you can see,
the programs are starting to develop from coast
to coast. At AMB, we are striving to help the
EMS world provide better health care to our
communities. We know the success of these
programs will rest on the relationships the
health care providers can nurture. We have been
doing extensive research so we can be a source
of information for you. We want to hear from
you! Are you interested in bringing Community
Paramedicine to your service and community?
— Ashley Brooks CAC
SPRING • 2015
Employees of the Year:
Heather Davis
System Admin
Heather joined AMB in October of 2011, after working
for a division of the Credit Bureau for 4 years. She initially
started out as an A/R Follow-Up Representative, but moved
to System Administration April 2013. Her experience in
A/R Follow-Up has made her a valuable asset in System
Administration. Her roles include collection processing,
web portal and system training, database build out, and
anything else asked of her. Recently, Heather was asked
to spend a considerable amount of time on-site with a
new client. Not only did she prove to be helpful to both
companies, she also kept up with her normal day-to-day job
duties, sacrificing evenings and weekends. This is Heather’s
second consecutive year to be awarded Employee of the
Year!
Tanner Lear
Financial Analyst
Tanner has been with AMB/MARS for 1 ½ years and is a
vital part of our Reporting team. Tanner came to AMB/
MARS after working as a financial analyst at a local
hospital, and was able to make an immediate contribution.
Tanner’s keen analytical skills and personable demeanor
make him a valuable asset to both our internal and external
customers. Tanner is always willing to assist in explaining a
report or build a new one.
Introducing Supervisor of the year:
Tammie Horbovetz
Posting, Refunds, and Treasury Supervisor
Tammie has been a supervisor for the Posting and Refund
departments for a little over 1 ½ years. Just recently, she
was given the responsibility for the Treasury department.
Tammie’s professionalism, positive attitude and tenacity in
working with those in her departments made her an easy
choice for Supervisor of the Year 2014. Tammie’s career at
AMB/MARS started as a payment poster. She was quickly
promoted to the team lead of the Refunds department and
from there it did not take long for the management team to
recognize her leadership capability. Tammie has been with
us for over 7 years.
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MARS / AMB
the