CAC Course Topics
Module 1 – Pre-Billing
Module 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 – CAC Introduction
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 – TAP: Terminology, Anatomy and Physiology
Lesson 1B covers basic human anatomy and physiology, as well as terminology used in the typical Patient Care Report.
Lesson 1C – Call Intake and Dispatch
Lesson 1C examines the important roles that Dispatch and Call Intake information play in determining the proper levels of service to bill.
Lesson 1D – 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
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 the complex issues surrounding required signatures including who can sign on the patient’s behalf, and when.
Lesson 1F – Forms
This lesson covers two critical forms that ambulance billers and coders must understand for compliant billing – the Physician’s Certification Statement (PCS) and the Advance Beneficiary Notice (ABN). We’ll discuss when each can be used, who can sign, and how to ensure that it’s valid.
Module 2 – Payers
In Module 2 we discuss the policies and rules of various payers encountered by the ambulance biller.
Lesson 2A – Medicare
For most ambulance services, Medicare is the single largest payer. Medicare is also the payer 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 2B – Medicaid
Medicaid is managed by each State, so rules vary widely. Some of the challenges discussed include dual eligibility, retroactive eligibility, Medicaid Managed Care, and Transportation Brokers.
Lesson 2C – Facilities
When is a Facility responsible for payment for the transport? Which facility is responsible? This session also discusses such topics as free-standing emergency rooms, hospice and compliance issues with facilities.
Lesson 2D – Commercial Insurers
In this lesson we will discuss rules and strategies for billing commercial insurance. We’ll also cover billing auto insurance, workers compensation, liability insurance and TriCare.
Lesson 2E – Self-Pay
Lesson 2E covers problems encountered when the patient is the payer such as documenting interactions, dealing with attorney representation and suing patients for payment.
Module 3 – Coding
Module 3 covers the various types of codes ambulance billers and coders must know and understand.
Lesson 3A – Procedure Codes
In this lesson we discuss, in detail, the various levels of ground and air ambulance service and what determines the proper level to bill and the Healthcare Common Procedure Coding System (HCPCS).
Lesson 3B – 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 3C – ICD-10 Codes
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 3D – Coding Skills
Lesson 3D allows participants to test their knowledge of what they’ve learned in class to apply HCPCS , modifiers and ICD-10 codes to real-life scenarios.
Module 4 – Revenue Cycle Management
In Module 4, the participant will learn how to manage the process from claim production through collections.
Lesson 4A – Claim Production
Lesson 4A covers the process of verifying that all 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 including understanding standardized code sets and standard transactions.
Lesson 4B – Remittance and Posting
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 4C – Denials, Appeals and Collections
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. We’ll also discuss internal collections vs. external collections and the laws regulating collections.
Module 5 – Compliance
In Module 5 we will cover all 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 – Healthcare Fraud and Abuse
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 – Privacy and Confidentiality
Few laws have impacted day-to-day operations in an ambulance billing office the way HIPAA has. We will cover all the important rules and regulations that the ambulance billing staff need to be aware of to insure compliance with these standards.
Lesson 5C – 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.