Your business’s revenue cycle is the process of converting billing for ambulance services to eventual cash revenue.  From call intake to provider documentation, to capturing required signatures, to proper code and modifier selected, to claim submission, remittance and posting, to denials, appeals, audits, overpayments and refunds, PWW advises its clients on the full range of issues that impact its revenue cycle.  We help clients measure important performance parameters (Key Performance Indicators) for both billing and compliance.  We also perform billing and compliance assessments and help our clients re-engineer their billing office processes for maximum efficiency.

Some of our Revenue Cycle Performance related professional services include:

On-Site Billing Assessments

PWW’s billing assessment will provide you with a detailed assessment of your organization’s billing functions.  Our assessments are customized to the client’s needs and can include:

1. Review of in-house compliance programs
2. Detailed analysis of the client’s billing and collection history to identify areas of opportunity for performance improvement
3. Operation reviews of the billing function to determine the appropriateness of systems and resources to perform activities
4. Analysis of revenue loss from medical necessity with recommended changes to follow-up procedures to insure greater compliance
5. Examination of fee schedules, provider arrangements and ICD9 coding with recommended changes to address situations where bills are denied or inadequately paid
6. Review of internal processes with recommendations for streamlining gathering patient information, following up on missing information and the collection effort

Billing Process Improvement

As reimbursement declines and overhead rises, ambulance companies can’t afford anything short of a perfect billing and collections process.  PWW will review the following processes to make sure your billing procedures are efficient:

1. Review documentation to ensure consistency between the dispatch documentation, the PCR and the PCS or facility records
2. Ensure training program provides a proper understanding and application of dispatch and call intake for proper coding of ambulance claims for the many levels of service
3. Understanding your agency’s as well as local clinical protocol’s and the interaction between clinical protocols and proper billing
4. Incorporating a highly-functional interal audit process into your compliance programs.

KPIs and Performance Measurement

Your most crtical measurements are called Key Performance Indicators.  We’ve all heard the saying, “What gets measured gets done.” It means regular measurement and reporting keeps you focused — because you use that information to make decisions to improve your results.  KPI’s are a small number of agreed-upon measurements that reflect your organization’s critical goals for success.  They are measurable, objective, and actionable.  Some of the KPI’s we look at to determine the efficiency of your organizations are:

Billing

1. Days Sales Outstanding (DSO)
2. Average daily net charges
3. Net Payment to Gross Charges
4. Net Payment to Net Charges
5. Percent of Accounts Receivable over 90 days
6. Average Performance of Payors
   • Medicare
   • Medicaid
   • Facilities
   • Insurance
   • Patient
7. Weekly Cash by Payor

Finance

1. Cost per Unit Hour
2. Cost per Transport
3. Monthly Actual vs Budget Analysis

By monitoring your billing KPI’s you will be able to identify billing problems before they get out of hand, track performance of the billing functions and make informed decisions on rates and managed care contracts. Focusing on your finance KPI’s will provide better monitoring and control of expenses, focus financial resources where they are most needed and provide the ability to measure results of additional operating expenses.  PWW is prepared to assist your organization in determing the Key Performance Indicators that will make your agency most successful.