Improper Medical Billing Reimbursement for Ambulance

Improper Medical Billing Reimbursement for Ambulance

A recent study shows that United States citizens are paying dearly for incorrect and unwarranted medical billing payments. The Office of Inspector General (OIG) has suspected for a long time that Medicare and ambulance benefits were and are vulnerable to abuse. Apparently, the OIG was correct. A medical billing study of 720 ambulance claims has shown significant overpayments.

A whopping $402 million was paid in incorrect ambulance charges in the year 2002. This study is based on transports for emergency, non emergency, and transports to and from dialysis facilities. The OIG now blames Medicare contractors for these medical billing overpayments. They state that proper safeguards were not in place to protect the system from fraud.

Amazingly, thirteen out of the 720 cases accounted for over half of the overpayment money. 5% of the medical billing overpayments were the failure to respond to OIG requests for documentation. 9% of the medical billing overpayments were for a failure to maintain a level of service criteria. $220 million was paid for ambulance transport in situations that simply did not warrant an ambulance.

These improper medical billing payments have wasted over $400 million Taxpayer dollars. The OIG does have a recommendation for the Centers for Medicare and Medicaid services. They have suggested the agency installs edits that target non emergency and dialysis ambulance transports. They also suggest that ambulance providers include documentation with their medical billing claim submissions.

It is unfortunate that Medicare recently had to cut provider payments. Perhaps payment cuts and slashes would not need to be made if medical billing overpayments were eliminated. The only way to eliminate overpayments is to install safeguards. Your practice should not suffer while another practice gains from unnecessary medical billing reimbursement.

View all Articles by: Melissa Clark, CCS-P